Day: February 26, 2012
Less Choice, Lower Cost
Do all PPO contracted providers have the same contract? The answer is “NO”.
Molly Mulebriar reports that her cousin, insured by one of the largest health insurance companies in Texas has first hand proof. Mulebriar has an EOB for a specific outpatient CAT Scan for services provided at two different outpatient clinics. Both facilities are within five miles of each other. For the same exact procedure, the PPO contracted price variers by over $1,500.
When asked, a local sales representative for this carrier owned PPO network stated “Bill, all our network providers have agreed to the same pricing. We dont pay one provider more than another provider. We use standard contracts.”
Mulebriar disagrees. “Bill, I have copies of EOB’s that show otherwise. ” (This blog will publish those EOB’s soon).
Same procedure, same exact billing coding, same PPO network, vastly different pricing.
We are now seeing carriers and PPO networks touting new “mini-PPO networks. They are simply carving out those providers who have agreed to lower pricing and calling the network any number of names, such as Platinum Network, etc. We call it the SBPPO Networks (http://blog.riskmanagers.us/?p=7261) – (http://blog.riskmanagers.us/?p=7246)