Cash Cows & Smoke Filled Rooms

smokefilledroom

“A national health care conspiracy between medical care givers and third party intermediaries has created a lucrative cash cow crafted through secretive collaborative contracts of adhesion in smoke filled rooms.” – Molly Mulebriar

By Molly Mulebriar

Why would an employer pay money to access a contract to which they are not a party and to which they have no clue as to the price of goods? And, how does the employer know if his plan is paying a fair and reasonable price for health care?

Furthermore, how does the employer know if the full “discount” is passed 100% to the consumer? The answer is: The employer doesn’t know. A South Texas school district, for example, learned through discovery their PPO provider was charging 9.6% of claim savings as an additional fee, above and beyond all other fees.

 “What a poor business decision this is! If my CFO entered into such an agreement I would fire him immediately”. – Homer G. Farnsworth, M.D.

What an employer may find disturbing is that the out-of-network hospital down the road, providing the same quality of care, may be less expensive than the in-network hospital across the street. A lot less expensive.

The employer may also be unhappy to learn that many PPO networks not only derive income from the “access fee”, but through other fees, never disclosed to the employer, such as a Provider Re-Pricing Fee, Clearing House Fees, and other fees that may or may not be included. These fees are disguised as “claims” and show up on the claim side of the ledger. I guess what we don’t know won’t hurt us.

So why would employers enter into agreements upon which they have committed to paying for health care, not knowing what the cost of goods and services they will be required to pay? That just doesn’t make sense, does it?

The answer is not complicated at all. A national health care conspiracy between medical care givers and third party intermediaries has created a lucrative cash cow crafted through secretive collaborative contracts of adhesion in smoke filled rooms.

Purveyors of the “Gospel” emerge from these smoke filled rooms prior to renewal, espousing a never ending message of new and steeper discounts that, they insist, can’t be beat by the competition.

That is certainly good news in the never ending world of turbo-charged health care billing……At least that is the intended message.

Employers acquiesce. The conspiracy continues………………………

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