A new bill introduced in the US Senate, if passed, will lead to
extinction of PPO’s in this country. If consumers and plan sponsors are able to access the Medicare network at Medicare pricing, (Renting Medicare’s Provider Network) why would anyone stay with a PPO with pricing averaging two, three, or more times than Medicare pricing? Would you?
Purveyors of Reference Based Pricing strategies will rejoice because instead of paying 120% to 150% of Medicare now, they will swiftly reduce the benchmark to, at a minimum, 100% of Medicare allowable. And, I expect, some plan sponsors will tag their reimbursement to 80% of Medicare allowable as a cost sharing measure with plan members……………Bill Rusteberg