“………hospitals can no longer expect to get reimbursement from health plans in amounts well in excess of the actual value of services provided to plan members…………”
Continue reading Ruling: Hospital Bills Should Reflect ‘Reasonable Value’ of Service
“………hospitals can no longer expect to get reimbursement from health plans in amounts well in excess of the actual value of services provided to plan members…………”
Continue reading Ruling: Hospital Bills Should Reflect ‘Reasonable Value’ of Service
Texas law gives patients the right to request, in advance, estimates of charges from providers and facilities and estimated payments from health plans. Providers, facilities, and health plans have 10 days to produce the estimates – The Texas Department of Insurance
Why don’t Plan Sponsors in Texas use this little known law as the basis of a pre-cert program? Precertification of what the plan will pay and what the patient will be responsible for prior to services rendered. We have been doing exactly this on most dental plans for years.
Traditional stop loss participation requirements will prevent many employers from pursuing an affordable self-funded solution for ACA-compliance.