Compared To Medicare, What Does Blue Cross Pay Providers? Medicare + 130%, 216% or 129%?

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Editor’s Note: Managed care contracts are closely guarded secrets. Try getting your hands on one and you will understand the difficulties involved in learning the truth behind managed care contracts. We have succeeded in obtaining copies of contracts, including the Holy Grail, a Blue Cross hospital contract, but that is another story to be told some other time. The following article provides the reader clues about what Blue Cross pays on their North Carolina providers contracts and the difficulty in obtaining pricing information from major health insurance carriers.

The Segal Company, according to this article, has determined that on average Blue Cross pays 130% of Medicare towards professional services (physicians), 216% for out-patient hospital services and 129% for in-patient hospital services.

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Continue reading Compared To Medicare, What Does Blue Cross Pay Providers? Medicare + 130%, 216% or 129%?