For most ASC administrators, getting a major commercial payer to return a phone call about contract negotiations is a victory in itself. Getting two of the country’s largest insurers to sign off on a fundamentally different pricing structure altogether is something else entirely.
That is what Zionsville, Ind.-based WellBridge Surgical Center has done. According to newly named President Tom Valentine, WellBridge is the first facility in the country to have charge masters with both Anthem and United Healthcare covering a complete list of outpatient CPT codes at all-inclusive bundle pricing.
For many ASCs, payer relations are the biggest burden on their bottom line. Reimbursement rates have not kept pace with inflation, staffing costs have surged and some commercial payers have effectively closed the door on negotiations.
For most ASC billing, a single outpatient procedure can generate a facility fee, a separate anesthesia bill, a surgeon fee, a pre-op consultation charge and postoperative costs, all arriving at different times, from different billing entities, with different payer rules applied to each.
Suzi Cunningham, administrator of Advanced Ambulatory Surgery Center in Redlands, Calif., told Becker’s she has been fighting the payer battle on multiple fronts simultaneously, and she even received a message from a commercial payer announcing it was not opening contract negotiations with any ASCs.
“They’re going to run independent ASCs out of business,” she said. “Or they’re going to force us into joint ventures and mergers — with large ASC management companies or hospital systems — because those entities have the contracting leverage and economies of scale that a small independent operator simply doesn’t have.”
Other ASC leaders echo concerns about the typical multi-bill experience and payer friction.
“The most frustrating part of working with payers today is the lack of transparency and consistency — particularly around prior authorization, medical necessity determinations and reimbursement methodology,” Ashley Hilliard, RN, administrator of Winston-Salem, N.C.-based Piedmont Outpatient Surgery Center, told Becker’s. “Requirements change frequently; interpretations vary by payer and even by reviewer, and there is often no clear, timely way to resolve discrepancies. This can lead to delays in patient care, reduced access, administrative burden and financial uncertainty. These issues can have a negative impact on the patient, as well as the ASC.”
WellBridge’s model aims to disrupt this process.
“The traditional reimbursement system rewards complexity rather than efficiency,” Mr. Valentine said. “If your goal is to provide predictable, affordable surgical care, you eventually realize that operating entirely inside conventional insurance limits your ability to innovate around pricing and patient experience.”
An anesthesiologist and entrepreneur co-founded WellBridge on the premise that high-quality outpatient surgical care could be delivered transparently, predictably and at a fraction of what hospital systems were charging, and that commercial payers could be part of that equation rather than obstacles to it.
The decision to pursue commercial payer relationships rather than operate purely on a cash-pay basis is what made the bundle pricing negotiation both harder and more meaningful, Mr. Valentine said.
Getting Anthem and United to the table did not happen overnight, and perhaps surprisingly, hospital systems were what made the shift possible.
As large health networks began pursuing direct employer contracts, attempting to cut insurers out of the equation entirely, commercial payers suddenly had a reason to look more favorably at lower-cost alternatives. WellBridge’s all-inclusive pricing, even with broker and TPA costs factored in, came in 50% to 60% below what hospital systems were offering employers directly. The math made the conversation a lot easier, Mr. Valentine said.
“I don’t want to go into the bar fight by myself if I’m outnumbered,” Mr. Valentine said. “Pull the big guy in and let’s really do something.”
Commercial insurance prices were 78% higher in hospital outpatient settings compared with ASCs in 2024, according to a Health Affairs study. The study found commercial prices for 13 common outpatient procedures averaged $1,489 higher in HOPDs than ASCs. For comparison, Medicare rates were 97% higher in HOPDs for the same procedures.
“There are a lot of self-insured businesses out there trying to find their way through the idea that they can significantly cut employee healthcare costs,” he said. “WellBridge is an answer to that problem, and I intend to prove the model works — and then take it elsewhere.”
According to the Kaiser Family Foundation’s 2025 Employer Health Benefits Survey, 67% of covered workers are now enrolled in self-funded plans, including 80% of large-firm employees.
WellBridge gave these companies a line-item answer: Here is what your employees spent on these specific CPT codes last year, and here is what it would have cost at WellBridge. That kind of concrete, procedure-level comparison gave employers something to act on, and gave payers a reason to engage.
The all-inclusive model is easy to explain but difficult to execute.
“You have to understand your costs at an extremely granular level: implants, staffing, anesthesia, surgeon fees, supply utilization, room-to-room turnover times, everything,” Mr. Valentine said. “In traditional fee-for-service healthcare, inefficiencies get buried inside the reimbursement structure. In our model, they can’t.”
WellBridge’s model remains an outlier. But Mr. Valentine said the conditions that made it possible — employer desperation, payer self-interest and a healthcare cost environment that has become untenable — are only intensifying.
“Employers are actively looking for alternatives because healthcare costs have simply become unsustainable,” he said. “The market is creating the demand for models like ours.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.