Archive for September 18th, 2011

Risk

Sunday, September 18th, 2011

Some employers measure risk through premiums charged. Others measure risk through more independent means.

– Molly Mulebriar –

Washington State Department of Labor & Statistics Releases ASC Fee Schedule

Sunday, September 18th, 2011

                      Washington State Department of Labor & Statistics publishes Ambulatory Surgical Center Fee Schedule in July 2011 – http://www.lni.wa.gov/ClaimsIns/Files/ProviderPay/FeeSchedules/2011FS/fsAsc.pdf.

As a self-funded employer, how does this compare to what your Plan is now paying? You may be surprised at the cost differentials.

We recently reviewed an ASC claim on a hand surgery in Greater San Antonio Texas  – ASC charge was about $98,000, surgeon was about $38,000, and the ancillary lab and x-ray brought the overall total to right at $150,000. We did not pay this amount of course, rather we sent them a check for much less. In fact, the check we sent was not enough to even buy a 2011 Four Wheel Drive, Delux Chevy Truck with leather seats.

Unfortunately this example is not uncommon. How about an ASC charge for a deviated septum on a 12 year old patient coming in at about $60,000? Yep, it really did happen. We paid the ASC $2,500 instead.

Seems that if you have insurance, you pay more. Employer Sponsored Cash Plans reign supreme.