Converting PPO “Discounts” To Medicare Allowable

They were floored and shocked to find out that the 60% discount of billed charges in their area actually converted to 270% of Medicare charges!……………

By Jeff Bernhard, President of Continental Benefits

I had the opportunity to present to a very large Employer this week at a Final’s meeting. All the talk was about network discounts and how big our discount was compared to the other PPO networks.

I actually showed the leadership what they were getting, as a percent of Medicare, with their current 60% discount. They never saw this transparent conversion before. They were floored and shocked to find out that the 60% discount of billed charges in their area actually converted to 270% of Medicare charges! Yes, 270% of Medicare charges and all of the the networks were at that discount level around there.

This is the type of transparency every CFO and Board of Directors should be asking for. They have a fiduciary responsibility to do so. Ask what Percent of Medicare does my large 65% discount of billed charges equate to?

At Continental Benefits we do this for all customers. It opens eye’s wide open. The customer is considering the Continental Benefits direct network that was built at 130% of Medicare. They will save millions of unnecessary medical spend – good ending! Lesson learned: Always know what percent of Medicare you are paying for your healthcare plan. Discounts are very deceiving.

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