Hospital billed charges total 1661% of Medicare. A typical PPO “discount” would be between the range of 50-70%. If the later, the hospital would be paid about 498% of Medicare. Plan paid 180% of Medicare. Hospital still wants more money. Plan sponsor says “Not in my lifetime!”
Below is part of an email received today from the audit company we use to re-price claims and negotiate settlements:
Good Morning,
The above claim was turned over to Medicredit for collection efforts. The balance listed on the notice is $6,856.76, which means there was an adjustment of $53,949.51. Because of such a large adjustment, we would like to attempt to negotiate a settlement.
Below are more details.
GBC: $68,192.66 (billed at 1661% of Medicare)
Allowed: $7,386.39 (paid at 180% of Medicare)
Savings: $60,806.27
If the Plan agrees to pay $6,856.76, the total allowable would be $14,243.15 and would equal 347% of Medicare.
Employer Response:
200% of Medicare. That’s the max. MediCredit can shove the balance up a place where the sun doesn’t shine.
PS, I don’t consider $54,000 as “savings”. I consider that not giving in to extortion.
