Most insureds have no idea what their insurance plan pays for an MRI. And they really don’t care since “insurance pays the bills.”
But they should care. After all, their premium rates are directly proportional to medical care costs. Insurance companies are simply conduits for health care revenue flows, taking their cut as money cascades it’s way through the health care system honey pot.
Insurance companies are not the only ones with a vested financial interest in health care costs. Many intermediaries participate in the cash cow we call the American Health Care System. Brokers of all sorts earn high fees. Some medical providers have partnership agreements with these brokers and participate in revenue streams.
Ever heard of an MRI broker? They exist. Their sales pitch is something like this: “Our services are free! Just call our toll free number and we will find the best and lowest cost MRI for your employees, as needed. We will even set the appointment! While the average MRI charge in your area is a whopping $2,500 after the PPO discount, we have been able to get the same MRI in the same area for as low as $900! And you pay us nothing – we participate in the $900 “discounted” price and the MRI center pays us!”
And, some doctors refer patients to MRI centers that pay the doctor a “kickback.” Unfortunately, in some localities, this is very common practice.
The MRI business model, as practiced by most, is extremely lucrative for many participants. Very lucrative.
Now enters RPN of California. Their MRI business model is based upon the novel concept of connecting the payer directly with the provider and eliminating all the middle men. For $295 per MRI, this company makes a nice profit, and the payer saves money. Keep your eye on RPN. You will hear more about them in San Antonio, Texas.
Why San Antonio? A market analysis shows 37 MRI locations and their average costs: http://www.newchoicehealth.com/Directory/CityProcedureType/Texas/San%20Antonio/15/MRI . Statistics show that there are 91.2 MRI’s per 1,000 population. Based on this statistic, there are approximately 192,000 MRI’s performed annual in the San Antonio area, or 524 MRI’s per day.
For more information on RPN, visit www.rpnofcalifornia.com
Editor’s Note: See similar posting – http://blog.riskmanagers.us/?p=5864 Health care professionals like RPN bring competition to the health care marketplace. That is good for consumers.
“Once we rid ourselves of traditional thinking we can get on with creating the future”
– James Bertrand
