A Fairy Tale Come True
By Bill Rusteberg
“PPO’s drive up costs!” said the new era benefits broker “Do away with them and you will be glad you did! Your savings will be something to write home about!”
“We’re with you!” said the CEO of a local free-standing ER. “PPO’s are bad for our business too!. We did away with them with good success, enjoying record profits that would make even Bernie Madoff blush with envy!”
“That’s interesting” said the new era benefits broker. “We save money, you make more money, so it’s a win, win situation for both of us. How cool is that!”
“Right on, you get it!” said the grinning free standing ER CEO. “And that’s not all! We are now able build a NSA backed four-year annuity in addition to earning more than the law allows. We often redeem accrued annuity assets before the maturity date without penalty with the help of our attorney partners in Houston.“
“Really? How’s that?” said the new era benefits broker.
Ahhhhh………..I knew you would ask!” said the free-standing ER CEO. “We bill high, averaging 1,800% of Medicare knowing we won’t get it. Insurors pay low, typically around 180% of Medicare hoping we accept it. We don’t. So we take balance billing disputes to arbitration where we win 80% of the time, well north of 350% of Medicare. Balance bills that we don’t take to arbitration expeditiously are never forgiven, only stored in our “annuity” for future redemption before the four-year statute of limitation expires.”
“So you see, we both benefit!!” continued the free standing ER CEO. “And so do plan members. The get immediate access to care rather than having to wait days and weeks to see a primary care doctor. They don’t understand or care we are a grossly expensive ER provider, they think we are a urgent care provider. And they know we have to see them and they know they are protected against balance billing. They love coming to us
Such is the state of the unintended consequences of government interference in American health care financing. The No Surprises Act and the Minimum Loss Ratio mandate are just two examples of how government diktats, however good the intentions are, continue to erode incomes and job security of working Americans.
The now confused new era benefits broker suddenly has an epiphany. “I know what we will do! We will blacklist every free-standing ER and exclude them from our benefit plan. We will inform our plan members they now have a 100% benefit………………a 100% co-insurance benefit!”
And the new era benefits broker and his plan sponsor client lived happily ever after.
The End
