“We have the best discounts!” says the BUCA owned TPA rep. “Just ask any of our providers and you’ll see its true!”
So we did.
“I get paid more than Dr. Smith who’s on the same network!” says Dr. Jones. “We are both cardiologists, doing the same work. Smith is an idiot. He’s leaving money on the table! And get this, he’s labeled a ‘High-Value’ provider. Valued to who? Besides, if all providers in our network have the best discounts as the BUCA owned TPA claims is the case then all of us would be paid exactly the same and that’s simply not true!”
“Ah, so not all providers in your network have the best discounts” says an astonished plan sponsor. How do we know we are getting the lowest possible price?
“Glad you asked!” replies the BUCA owned TPA rep. “We have the ENGAGEMENT REWARDS program!”
“This program rewards members for researching and choosing high-value, “green” providers for a variety of inpatient or outpatient procedures. Incentives range anywhere from $25 up to $1,500 under the Engagement Rewards model. It includes over 400 eligible searchable procedures, representing 20 percent of medical spend. These can span from diagnostic procedures, like an MRI or CT scan, to surgeries, sleep studies, biopsies and more. Rewards are released on the back end after claims are processed—and all in all, the program encourages members to become good shoppers, while passing savings back to employers. Return on investment (ROI) for this program varies by client and member population, but we can show you how to maximize results.
“So when you say you have the best discounts that depends on who the provider is right? And how do you know how each provider’s managed care contract compares with competing managed care networks?” asks the plan sponsor.
“Just trust me Ok!” retorts the now sheepish BUCA owned TPA rep last seen crawling under a rock pulling and tugging his voluminous, ever changing and beautifully bound PPO network listing after him.
