Archive for October 16th, 2012

Stratose Announces Medicare Pricing Solution

Tuesday, October 16th, 2012

We are hearing more about non-managed care approaches to reigning in health care costs. This is a hot topic these days among insurance brokers and consultants. Now we learn that Stratose, formerly known as Coalition America, is pushing Medicare based benchmarking for payment of medical claims. (www.stratose.com )

They recently announced they have entered into an agreement with First Health.

The movement is spreading fast. In the past year we have identified numerous entities entering the non-managed care arena, either on the auditing, repricing and legal indemnification side, or in combination of two or all three elements.

As we see it, Group & Pension Administrators (GPA)  started this payer revolt against PPO networks with the introduction of their Cost Plus program over 4 years ago. (Bill Miller Forbes) GPA’s competitors have taken note, and employers are paying attention.

http://www.stratose.com/documents/Medicare%20Pricing%20Solutions%20FINAL.pdf

Is Cigna Dental Pulling A Fast One On Dentists? Dr. Pruitt Opines

Tuesday, October 16th, 2012

Is Cigna Dental pulling a fast one on dentists?

I received an intriguing call from a Cigna Dental rep today. She offered to direct Cigna’s fee-for-service customers to my practice “even if you are out of network,” with free advertising targeting Cigna’s customers. What’s more, she promised no fee restrictions – allowing me to charge what the market will bear.

Since the offer seemed too good to be true, I patiently awaited the hook. Finally, she mentioned that all that is required of me is to share the profits with my current Cigna PPO patients by giving them “just a little better discount.” Judging from her surprise when I told her that I don’t participate in Cigna or any other PPO plan, I suppose I am one of the very few these days.

Obviously, sales reps prefer relevant leads than to waste time cold calling, making the call this morning seem odd. So I suspect Cigna is conducting a clever ruse intended to enroll more dentists into Cigna PPO plans. If I am correct, could this be a sign that discount dentistry brokers like Cigna are finally having to compete with Delta Dental and other managed care plans for willing dentists?

If there are any Cigna PPO dentists in the audience, I am especially curious to know if you received the same advertising offer. Regardless, what are your thoughts concerning this puzzler?

Dentists who might be considering Cigna’s free advertisement offer I described earlier today should be reminded that nothing is free.

The clever executives responsible for this unfolding scam are awarded bonuses for lowering dentists’ payments – not for treating dentists fairly. Dentists are personally accountable to the welfare of their patients. Cigna employees are not. Cigna’s only obligation is to investors and as long as there is no transparency such as offered in this post, they have nothing to lose.

If I were running Cigna’s scam, and had no ethics, I would have already quietly increased my boss’s market share by signing up more preferred providers at an even lower pay scale than Cigna’s current PPO contracts. Then, shortly before the insurance renewal anniversary for a dentist’s new and existing fee-for-service Cigna clients, I would pull the rug out from under the vulnerable dentist by encouraging his or her patients to switch to a PPO plan their dentist already accepts – at even greater discount than other available Cigna PPO plans.

Like most good scams, this one is beautiful in its simplicity (as long as stoic dentists don’t discuss it with each other).

Dr. Pruitt is a practicing Texas dentist. His email address is darrelldk@tx.rr.com