Brownsville ISD Takes HealthSmart to Court (Cont.)

The BISD’s group medical plan costs appear to have spiked when the district transitioned from Texas True Choice PPO to HealthSmart PPO. Why one wonders? Did Texas True Choice have better discounts with area providers?

In researching this we  went back to our reference files in our office. In our continued quest to learn the truth about PPO contracts, we have accumulated a wealth of information.  Our records reveal interesting information we obtained from the Valley Baptist website several years ago.  Posted on one of their web pages was a listing of their managed care (PPO) contracts along with reimbursement rates paid by each PPO network. Texas True Choice and HealthSmart were listed.

Here is what the website page showed:

Texas True Choice: “The fee schedule is based on 140% of the Current Year RBRVS schedule for E&M (90000), Radiology (70000), and Path/Lab (80000) Codes. Surgical (1000-69999) Codes are reimbursed at 165% of the Current Year RBRVS. Anesthesia Codes are reimbursed at 85% of Billed Charges. Immunizations, HCPCS and Codes without an allowable assigned are reimbursed at 75% of billed charges. Note; Covers Mutual of Omaha plans with BISD.”

HealthSmart Preferred Care: “The lesser of: 70% of billed charges or 135% of 2004 St. Anthony’s RBRVS on an aggregate basis. Covered procedures not listed or given a RBRVS value will be reimbursed at 70% of billed charges.”

See copy of Valley Baptist Webpage here –  Valley Baptist Managed Care Contract

Who has the better contract?

Editor’s Note: We would welcome a debate with anyone regarding PPO contracts.