Frequently asked questions
Introduction
What is Cost Plus Wellness?
Cost Plus Wellness is a public repository of healthcare contracts on the internet. Real ones, with real numbers. Every term, every rate, every pricing rule, all out in the open. The companies on this site agreed to drop confidentiality, so there's no fine print, no NDAs, no 'call us for a quote.'
Think of these as an open alternative to insurance carrier networks. Any employer can grab them and use them. Copy them, tweak them, hand them to your TPA. They are completely open source.
How did it start?
We started Cost Plus Wellness because employers are overpaying for healthcare. The biggest buyers in the country cover tens of millions of lives, and they still pay more than the person walking in off the street. Every carrier-hospital contract is bound by a confidentiality clause, plus payment terms that make it way more expensive for providers to do business.'
So we asked the obvious question: why not just negotiate direct prices for all of Mark Cuban's companies and employees? So we did. We've been using them ourselves for our own company plans. Every contract is now on this site, in full. Rates, terms, all of it.
What's your ultimate goal?
To make healthcare pricing transparent. By publishing contracts openly, we help self-funded employers build direct relationships with providers, removing intermediaries, lowering costs, and improving the quality of care.
How is Cost Plus Wellness different from Cost Plus Drugs?
Both are Mark Cuban-backed projects aimed at lowering healthcare costs through transparency. Cost Plus Drugs is a pharmacy that sells prescription drugs at published prices. Cost Plus Wellness is an open source project that helps self-funded employers contract directly and transparently with medical providers.
How does Cost Plus Wellness make money?
Cost Plus Wellness is an open-source project, not a business. We may at some point charge for our services, but right now our focus is simply to bring transparency to the market.
How direct contracting works
What is direct contracting?
Exactly what it sounds like. You (the employer, or your self-funded plan) sign a contract straight with the doctor or hospital. No carrier in the middle. You read the contract. You know the price before care happens. You pay the provider directly, instead of routing through a carrier's pricing system you aren't allowed to see.
What pricing methodology do the contracts use?
Most use a percentage of Medicare. Where Medicare pricing is a poor fit, contracts use fixed fees per case or custom rate schedules.
What's in the contracts, and what isn't?
What stays consistent is what's left out: no balance billing, no shared-savings fees, no kickbacks bundled into rates, no admin fees disguised as claims, and no anti-steering clauses. For the full breakdown, read the Employers guide.
Why fee-for-service instead of value-based?
Fee-for-service is simpler to administer and harder to game. Value-based formulas often hide incentives that benefit the contracting party more than the patient or the plan. We recommend employers use data to contract only with high-value providers rather than creating bespoke value-based contracts.
How do you avoid runaway utilization without prior authorization?
We use retrospective review instead of prospective gates. Outlier claims still get paid, but the provider gets a request for justification. Repeated unjustified outliers result in removal from the network. All employers should strongly incentivize care navigation to identify inappropriate utilization before it happens.
How do you factor in provider quality?
Mark Cuban Companies licenses individual provider outcomes and appropriateness data and uses it to help members find high-performing providers. Plans implementing Cost Plus Wellness can use that or any other quality data source they trust.
For employers
Who can use these contracts?
Self-funded employers, and some level-funded plans whose vendors will accommodate the model. They're explicitly not available to insurance carriers, or anyone acting on behalf of one.
How do I get started?
If you're self-funded with an independent TPA, you already have what you need. Head to get started for the first steps, or start an inquiry and we'll help you put the contracts to work.
What TPAs work with Cost Plus Wellness?
Sage TPA and The Kempton Group are the current implementation partners for employers who don't already have an independent TPA. More TPAs are being onboarded. If you want to use a specific TPA, contact us.
How do MRFs work for Cost Plus Wellness rates?
Self-funded plans publish their negotiated rates in Machine-Readable Files (MRFs) under federal transparency rules. Cost Plus Wellness rates are already public, so they drop straight into your MRFs, and most TPAs and vendors can include them without trouble.
What about HSAs and first-dollar coverage?
These contracts work with HSA-qualified plans, but IRS rules prohibit first-dollar coverage on most services in HSA plans. The plan still pays 100% of the negotiated rate to the provider, then collects the deductible from the member afterward.
What about Direct Primary Care (DPC)?
They fit together well. DPC covers everyday primary care for a flat membership fee, while Cost Plus Wellness contracts give you transparent pricing for specialists, procedures, and facilities. Pairing the two covers both ends of the spending curve.
How does Cost Plus Wellness work with Reference-Based Pricing (RBP)?
They complement each other. Cost Plus Wellness gives you upfront, contracted rates with participating providers, while RBP sets a defensible price ceiling everywhere else. Many plans use the contracts as the in-network core and lean on RBP for the rest.
What if my benefits consultant pushes back?
Most benefits consultants are paid by the vendors they recommend and don't owe your plan a fiduciary duty, so pushback is common. The Employers guide lists four questions worth asking yours.
How did Mark Cuban Companies implement this?
MCC rebuilt its self-funded plan around direct contracts after a single ER claim cost it three times the carrier's own fully-insured rate for the same care. Read the full story in How MCC implemented direct contracts in its health plan.
For providers
Who can post a contract, and what are the requirements?
Any healthcare entity, providers, brokers, consultants, and TPAs can post a contract on costpluswellness.com. Contracts must include full terms and rates, including any outlier provisions or carve-outs. All contracts are meant to be signed by employers.
How do you handle credentialing?
Providers are required to hold and maintain every license and certification their services require, and to verify them on request. Plans can layer on their own credentialing standards.
How do providers get paid?
Plans pay 100% of the negotiated rate within 30 days of receiving a clean claim. Providers don't collect from patients.
Are providers required to accept all employers using these contracts?
No. Providers opt in to each new employer individually. Once a provider opts in, we connect the employer and provider so they can complete signatures on their copy of the contract.
What if a provider is outside Dallas–Fort Worth?
Providers outside DFW can still publish a contract using Medicare-based rates, and it's visible to all employers. To start, head to get started.
What happens after I post a contract?
We review every submission and conduct basic verification. Once approved, your contract is published on costpluswellness.com where employers can find it and reach out to you.
Still have questions? Reach out at feedback@costpluswellness.com.