Before you read further brace ourself……….Cash Isn’t King at the ER at this Texas hospital. Neither is Blue Cross.
Not all hospitals have the same pricing but we have to wonder if these numbers are within an average mean among hospitals in Texas.
BUCA reps. are known to represent they have the best discounts, but who has the best prices?
Payer Negotiated Rates
CPT 99282: Emergency department visit for problem of mild to moderate severity
Service Gross Charge $518
Service Cash Price $311
Minimum Payer Rate $197
Maximum Payer Rate $497
| Payer Name | Plan Name | Negotiated Rate |
|---|---|---|
| Aetna | Commercial | $440 |
| Blue Cross Blue Shield of Texas | Blue Essentials | $497 |
| Blue Cross Blue Shield of Texas | PPO | $497 |
| Blue Cross Blue Shield of Texas | Traditional | $497 |
| Blue Cross Blue Shield of Texas – Blue Advantage | HMO | $451 |
| United Healthcare | Commercial | $197 |
Payer Negotiated Rates
CPT 99283: Emergency department visit for problem of moderate severity
Service Gross Charge $911
Service Cash Price $547
Minimum Payer Rate $346
Maximum Payer Rate $875
| Payer Name | Plan Name | Negotiated Rate |
|---|---|---|
| Aetna | Commercial | $774 |
| Blue Cross Blue Shield of Texas | Blue Essentials | $875 |
| Blue Cross Blue Shield of Texas | PPO | $875 |
| Blue Cross Blue Shield of Texas | Traditional | $875 |
| Blue Cross Blue Shield of Texas – Blue Advantage | HMO | $793 |
| United Healthcare | Commercial | $346 |
Payer Negotiated Rates
CPT 99284: Emergency department visit for problem of high severity
Service Gross Charge $1,431
Service Cash Price $859
Minimum Payer Rate $544
Maximum Payer Rate $1,374
| Payer Name | Plan Name | Negotiated Rate |
|---|---|---|
| Aetna | Commercial | $1,216 |
| Blue Cross Blue Shield of Texas | Blue Essentials | $1,374 |
| Blue Cross Blue Shield of Texas | PPO | $1,374 |
| Blue Cross Blue Shield of Texas | Traditional | $1,374 |
| Blue Cross Blue Shield of Texas – Blue Advantage | HMO | $1,245 |
| United Healthcare | Commercial | $544 |
Payer Negotiated Rates
CPT 99285: Emergency department visit for life threatening or functioning severity
Service Gross Charge $2,055
Service Cash Price $1,233
Minimum Payer Rate $781
Maximum Payer Rate $1,973
| Payer Name | Plan Name | Negotiated Rate |
|---|---|---|
| Aetna | Commercial | $1,747 |
| Blue Cross Blue Shield of Texas | Blue Essentials | $1,973 |
| Blue Cross Blue Shield of Texas | PPO | $1,973 |
| Blue Cross Blue Shield of Texas | Traditional | $1,973 |
| Blue Cross Blue Shield of Texas – Blue Advantage | HMO | $1,788 |
| United Healthcare | Commercial | $781 |
Does the largest employer in the county, the Carrizo Springs ISD, know they are paying the highest ER rates in town? And the hospital? What network do they access for their employee benefit plan? The answer might surprise you.
