Consumer Questions Doctor’s Charges

Yesterday we received an email from one of our clients, asking us to review his recent medical charges from a local physician. He wanted to know how the charges compared to 2008 RBRVS. Here is what we found:

CPT 86000        Billed $292.80                2008 RBRVS    $9.75  

This represents a +3000% markup from Medicare reimbursement formula.

About 6 months ago we moved an employer from a PPO plan to a plan that pays claims using 2008 RBRVS as a claim payment benchmark. To date the plan has saved approximately $500,000. And, we put in place a mechanism that addresses the balance billing issue so often raised by PPO representatives as a tactic to hold employers hostage to the PPO method of controlling costs.

Consumers should compare medical costs but most don’t

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