“The purpose of this notice is to formally advise you that University of Utah Health Care does not participate with ELAP or other “cost plus” plans being promoted in Utah or surrounding states.”
By Molly Mulebriar
Reference Based Pricing (RBP) / Cost Plus method of health care reimbursement started in Texas in 2007. That was nine years ago. Providers initially fought hard to suppress the movement, even going to such lengths as threatening plan sponsors with legal action, or worse, refusal to treat plan members, or both.
Nine years later Texas hospitals are still treating RBP plan members and cashing reimbursement checks. The consensus is RBP is here to stay, and growing rapidly. Whereas hospitals did not reach out to plan sponsors directly before, now we see a movement between hospital systems and employer groups forming collaborative efforts on a local basis as equal partners. Texas was an early adopter of RBP plans.
Utah is a late adopter……………..
It now appears providers in Utah are just now experiencing this wave change in health care reimbursement with forays into their state by health care revolutionaries.
The following letter is Stage 1 of Provider Denial Strategies:
(Note: For copy of letter write to RiskManager@RiskManagers.us)
“University of Utah Health Care, representing 4 hospitals and over 1,400 board certified physicians, has become aware of agents, brokers, and/or third-party administrators promoting the implementation of plans, such as ELAP Services, which discourage direct network and contract development with health care hospitals and providers. These programs intend to reimburse providers on a “usual and customary” or “Medicare cost plus” basis, and attempt to insulate patients or employers from collection attempts by providers.”
“The purpose of this notice is to formally advise you that University of Utah Health Care does not participate with ELAP or other “cost plus” plans being promoted in Utah or surrounding states. We will be advising employers and employees that any proposed discounted benefits offered by these plans will not be accepted without a formal, mutually signed agreement between the patient and University of Utah Health Care. Patients on these plans may be liable and financially responsible up to 100% of standard billed charges.”
“University of Utah Health Care has existing managed care contracts and partnerships with many reputable local, regional and national health plans, in which the parties have agreed to mutually acceptable terms and conditions that provide value and protection to your clients. We welcome and encourage plans that have full contractual and comprehensive network coverage to all University of Utah Hospitals and Clinics, and University of Utah Medical Group physicians.”
“If you would like to enquire whether a plan is fully participating with University of Utah Health Care, please contact me directly at 801-587-6484, or mark.zenger@hsc.utah.edu.”
Kind regards, Mark Zenger, MBA, MHA Senior Director, Payer Relations and Contracting University of Utah Health Care
From our experience, Stage 2 of Provider Denial Strategies will be forthcoming in approximately 15 months as more Utah plan sponsors adopt Reference Based Pricing schemes in that state.
Blitzkreig mop-up operations will begin, followed by a peace conference on board the USS Missouri, a floating barge replica in Salt Lake.
