Cost Plus Wellness for Employers

Introduction

Walk into a hospital with a credit card and you'll almost always get a better price than the largest insurance companies negotiate. That isn't an accident. Every carrier-hospital contract is bound by a confidentiality clause, plus payment terms that make care more expensive for everyone. The whole industry is built on you not being able to see what you're paying.

We started Cost Plus Wellness because employers are overpaying for healthcare. A lot. The biggest buyers in the country cover tens of millions of lives and still pay more than the person who walks in off the street. So we asked the obvious question: why not negotiate direct prices for all of Mark Cuban's companies and employees? We did. We've been running them for over a year, and now every contract is on this site in full, rates and terms and all.

We're putting healthcare contracts on the internet. Real ones, with real numbers: every term, every rate, every pricing rule, out in the open. The companies on this site agreed to drop the confidentiality, so there's no fine print, no NDAs, and no "call us for a quote."

Think of these as an open alternative to insurance carrier networks. Any employer can take them and use them: copy them, adjust them, and hand them to your TPA. They are completely open source. Some were negotiated by our team for Mark Cuban's own companies in Dallas. Others come from providers, brokers, and TPAs around the country who believe the numbers should be public too.

How does it work?

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.

Employers who start direct contracting routinely cut total plan spend by double digits, and members usually like the experience better. The system sitting between you and the hospital is built to take a cut at every step:

• They pay low and bill high (spread pricing). Carriers and PBMs pay one rate for a service or drug and charge your plan another. The gap is theirs.
• They own the providers you pay (affiliated entities). Carriers now own clinics, networks, and vendors that submit claims to your plan, at prices the carrier "negotiated" with itself.
• You pay more than the carrier's own customers (ASO arbitrage). The same carrier often charges a self-funded employer more for the same procedure at the same hospital than it pays under its fully-insured book.
• You can't steer members to a better deal (anti-steering clauses). Even when a cheaper, equally good provider exists, network terms can forbid you from sending members there.
• They charge you for "saving" you money (shared-savings fees). Carriers bill a percentage of every "discount," measured against an inflated list price you never agreed to.

Cost Plus Wellness extends direct contracting by publishing the contracts themselves, in full. Most employers don't have the legal team, market data, or provider relationships to negotiate their own. We're making this work reusable, so a 200-person employer can sit across the table from a major health system on equal footing.

How it works for employers

1. Review the contracts Cost Plus Wellness contracts are free to download and review. Identify the contracts and rates that would work best for your plan.
2. Contract directly with providers. Using our templates, your plan contracts directly with each provider. Some employers ask their TPAs to contract on their behalf. If you're ready to use one of our posted contracts as-is, email us to get started: info@costpluswellness.com
3. Your TPA processes the claims. Providers submit claims, and your TPA pays them at the transparent rate you contracted. We work with Sage TPA and The Kempton Group TPA today and are adding more on request.
4. Everyone wins. Providers get paid faster with fewer headaches, and you pay transparent, upfront prices.

What's in our contracts (and what isn't)

We don't lock in one pricing formula. Most contracts use a percentage of Medicare, since Medicare publishes regularly updated rates for almost every service. For services Medicare doesn't price well, contracts use fixed fees per case, custom rate schedules, or hybrids.

What stays consistent is what's not in there:

• No balance billing. Members never owe the difference between billed charges and the contracted rate.
• No shared-savings or "percentage of savings" fees.
• No kickbacks bundled into rates.
• No admin fees disguised as claims.
• No anti-steering or anti-tiering clauses.

Every contract is published in full, and these contracts are explicitly off-limits to insurance carriers or anyone acting on their behalf.

Can your plan use this?

Cost Plus Wellness is built for self-funded plans. Employers fund health plans one of three ways:

If you self-fund, you're basically running a small insurance company. That's a responsibility (you're a fiduciary for the plan's dollars) and a superpower (you can build a plan that works far better than what carriers offer off the shelf). Stop-loss is catastrophic-claim insurance that kicks in once an individual's claims pass a threshold.

A self-funded employer hires one of two administrators. ASOs (carrier-owned) look simple, but the carrier sets the rules and you can't carve out direct contracts. Independent TPAs unbundle these services, and that separation is what makes direct contracting possible.

To make this work you need: a self-funded plan, an independent TPA (or an ASO willing to pay claims at published CPW rates), and stop-loss coverage that recognizes CPW rates.

How Mark Cuban Companies does this

MCC hit the same problems every self-funded employer hits. The defining moment came on a single ER claim: the carrier's network required MCC to pay over $45,000 for an emergency visit, while the hospital's public price-transparency files showed the same carrier had negotiated $14,000 for the same services through its fully-insured book. Same hospital, same services, same carrier. Three times the price for the self-funded employer. That's when MCC stopped renegotiating the carrier contract and went straight to providers. Those contracts became the foundation of Cost Plus Wellness.

For the full story, including MCC's three-tier plan design, the vendors behind it, and the lessons from running it, read How MCC implemented direct contracts in its health plan.

Getting started

Already self-funded with an independent TPA willing to amend its plan documents? You've got what you need.

1. Benchmark your current claims against published CPW rates. Even before launch, this tells you how much your current network is costing you.
2. Confirm with your TPA that they can pay published rates within 30 days, waive prior auth, waive cost-sharing, route claims directly, and update plan documents.
3. Confirm with your stop-loss carrier and wrap network that they recognize the contracted rates and allow direct-contract carve-outs.

If you're fully-insured, start by figuring out whether self-funding is right for your size and risk tolerance.

If your consultant pushes back

Most benefits consultants get paid by the vendors they recommend, and they don't have a fiduciary duty to your plan. You do. "My consultant said so" is not a legal defense. If yours says this won't work, four questions worth asking first:

1. What are all the sources of revenue you or your firm earn, directly or indirectly, from our plan's current vendors?
2. Do we have a contractual right to all of our plan's claims data? If not, why not?
3. When you recommended our current vendors, what alternatives were considered, and why did they lose?
4. At our last renewal, did you try to unbundle the network, ASO, PBM, or stop-loss components? If not, why not?

Get started

Browse the contracts to see real pricing and terms, or start an inquiry and we'll help you put them to work.

Disclaimer

This is not legal advice. Always consult an attorney before signing any contracts.