BCBSMN ASO Agreement

A self-funded plan using BCBSMN as the Plan Administrator pays out-of-network providers 200% of Medicare. What do they pay in-network providers (Hint: it’s more).

The following are excerpts from a BCBSMN ASO Agreement:
Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to your Health Care Provider.
Sometimes, it is an estimated price that takes into account special arrangements with your Health Care Provider or provider group that may include types of settlements, incentive payments, and/or other credits or charges.
Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of Health Care Providers after taking into account the same types of transactions as with an estimated price.
Estimated pricing and average pricing also take into account adjustments to correct for over- or underestimation of modifications of past pricing of claims, as noted above. However, such adjustments will not affect the price the Claims Administrator has used for your Claim because they will not be applied after a Claim has already been paid.
Fee-for-Service-Providers are paid for each service or bundle of services. Payment is based on the amount of the provider’s billed charges.
▪ Discounted Fee-for-Service-Providers are paid a portion of their billed charges for each service or bundle of services. Payment may be a percentage of the billed charge or it may be based on a fee schedule that is developed using a methodology similar to that used by the federal government to pay providers for Medicare services.
Out of network : 200% of the Medicare Allowed Charge for the same or similar Service;
https://www.bluecrossmn.com/healthy/public/portalcomponents/PublicContentServlet?contentId=P11GA_15895535

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