Cost Plus / Medicare Benchmarking Continues To Gain Market Acceptance – Are PPO’s Facing Extinction?


“INETICO has put together a complete and effective option to the traditional PPO model……………..”

Editor’s Note: Cost Plus insurance, also known as Reference Based Pricing, is becoming a growing market phenomenon. In Texas, Cost Plus Insurance ( ) made a debut about 6 years ago.  A handful of employers who had the intestinal fortitude to step away from the managed care world, decided to purchase health care using common sense and traditional American business practices rather than rely on secretive managed care contracts between health care givers and their PPO partners.

The market was confined to one or two “Out-Of-The-Box” TPA’s who, much to their credit,  risked retaliation from the managed care industry. Their perseverance paid off – clients saved as much as 50% or more above and beyond managed care contracts – and TPA profits soared through a percentage of savings scheme or fees of up to 12% of billed charges that netted millions in new found wealth.

(Hospital Charge Master is an intermediary’s best friend – Hospitals Dismiss Significance Of Chargemaster Prices? – “greatest fraud foisted upon consumers since Vicor Lustig sold the Eiffel Tower in 1925″).

Markets evolve. Opportunities abound. Free enterprise rewards those who build a better mousetrap, keeping  competitors at bay through innovative strategies, good service and competitive pricing. (Xerox, Eastman Kodak And Cost Plus Insurance)

INETICO Enhances Medicare-Based Claims Repricing  as Alternative to Traditional PPO for Greater Claims Savings
MyHealthGuide Source: INETICO, Inc. 01/03/2014,
TAMPA, FL — INETICO, Inc., a leading provider of medical management solutions, has enhanced the process for Medicare based claims repricing to include effective front and back end measures that help protect the plan and the plan members while providing a viable option for the facilities and providers to receive prompt and mutually acceptable payments, without the need to collect member copays.
Recognizing the need to not only provide effective cost containment options for TPAs and Employer Groups, INETICO has worked diligently over the past several years with their claims and legal team, as well as with their existing client base, to develop a comprehensive Medicare Based Reimbursement Program — PAR3 — that guides the plan through the ins and outs of utilizing a Medicare fee schedule as a basis for claims repricing. From the language necessary to include in the plan documents and on the Member ID cards, to the administrators Customer Service training for member and provider questions to the Legal support on balance billing attempts, INETICO has put together a complete and effective option to the traditional PPO model.

  • An example of actual results, one plan achieved a YTD savings for 2013 utilizing the PAR3 program of 60.1% vs. what would have been their savings using a traditional PPO network of only 35%.
  • Stated differently, for every $1 of billed claims, the PAR3 model has saved $.25 or an additional 25% over the traditional PPO model.
  • For a group with $1M in billed charges for the year, an additional savings of $250,000 would occur. Now, who wouldn’t want to provide that additional savings to their clients!

The PAR3 model requires a strong partnership between INETICO and their clients. It is a joint collaboration making sure that the administrator, the plan and INETICO are all working in unison to not only set up the program properly, but to support the plan members through their customer service and member communication efforts. This type of partnership proves to not only provide exceptional outcomes, but enhances the working relationship of all parties involved..
For more information on the PAR3 Medicare Based Reasonable Reimbursement Program, contact or call (813) 258-2200 extension 1. You can also visit INETICO on the web at
About INETICO, Inc.
INETICO is a leading provider of medical and dental cost containment solutions to TPAs, self-funded plans, fully-insured plans, employer groups, MGUs and insurance carriers. INETICO’s innovative and integrated approach to Care & Claims Management provides clients with cutting edge technology and access to information that are unparalleled in the industry today. Most recently in 2013, INETICO introduced their Octane Wellness and PAR3 Medicare Reasonable Reimbursement Rate Claim Repricing programs to the industry receiving great accolades from their clients for the exceptional results achieved. INETICO, Inc. is headquartered in Tampa, Florida. Call  (813) 258 — 2200 extension 1 and visit