Molly Mulebriar, ace reporterette and forensic bulldog, reports that touted BCBS PPO discounts may not be all that they seem to be. “It could be a mirage” Mulebriar stated, “or deceptive trade practice, or neither.”
Mulebriar, in her continued quest for the truth, recently learned of a January 2011 hospital admission of a renouned celebrity from South Texas. Apparently, the patient was in need of emergency treatment, and sought help at Hermann Memorial in Houston. The condition warranted an overnight stay in the intensive care unit. The patient was insured by BCBSTX.
BCBSTX lists Hermann Memorial Hospital as an in-network hospital. Under PPO contracts, in-network providers agree to discount their fees for service. At least that is the theory.
But in this case, there was no discount at all. One could assume that BCBSTX brokered an agreement with Hermann Memorial that allows BCBS to list this hospital as an in-network provider, and nothing else. A good marketing ploy to be sure, but not so good to the financial health of the patient it seems.
Mulebriar has learned that officials within the Hermann Memorial system told the patient that there was no BCBS discount available on this particular claim. Officials spent 38 minutes on the phone with BCBS representatives to inquire, confirm that no discounts were available. Yet, when Mulebriar called the BCBS service office to inquire if Hermann Memorial was in-network, she was told “Yes, and of course we have negotiated steep discounts with the hospital.”
As evidence, Mulebriar offers the following documents : Memorial Hermann Northwest
Mulebriar writes “What is amazing is the hype surrounding PPO discounts and the savings that are to the benefit of the consumer. This patient purchased a product with an inherent promise that health care costs would be negotiated and discounted. The patient sought treatment at a directed facility based on representations made regarding costs, only to find that no discounts were negotiated at all. This is sad.”
