Cash Beats Managed Care Plans Every Time

Removing Financial Barriers To Health Care

This is how to remove all financial barriers to healthcare, improve benefits, and save money at the same time.

Here is an actual example of a cash paid claim for a Cesarean Section which occurred 8/31/21. The plan is a Reference Based Pricing plan which does not access any managed care contracts whatsoever. That’s because managed care contracts are not good for your financial health.

The reference price in this actual claim is 140% of Medicare. That is what the plan has decided to pay towards claims and RBP fees combined. Not a dime more.

Bear in mind the reference price in a typical PPO plan (allowed amount) is much higher than 140% of Medicare, averaging 225% of Medicare or more. Therefore the savings shown in the illustration below would be significantly higher under a PPO plan because of the higher starting point. The “savings” would be more under a typical PPO plan but the net cost would be the same as under a Reference Based Pricing plan. So the often shouted claim from brain dead status quo vendors of “I have the best discounts” really doesn’t mean anything at all.

This group is a Texas political subdivision.

Below is the shared savings calculation for a procedure for one of our members. The aggregate price for the procedure comes out to 73% of Medicare.

Note that the plan pays less and the member pays nothing towards the cost of care.

Reference Price Details Amount
Reference Price $16,502.30
Reference Patient Responsibility $4,765.96
Reference Plan Responsibility $11,736.34
Cash Price Details Amount
Total Cash Price (including Case Fee) $8,282.00
Patient Responsibility (without Savings) $2,751.90
Plan Responsibility (without Savings) $5,530.10
Total Savings $8,220.30
Member Savings or Discount $2,751.90
Patient Responsibility (with Savings) $0.00
Plan Responsibility (with Savings) $8,282.00

RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

 

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