Hospital Rejects 120% of Medicare, Accepts 105% Instead

If a hospital rejects 120% of Medicare reimbursement and turns non-emergent patients away, why do you think the same hospital would accept 105% instead?

We get daily cash pay reporting with results averaging Medicare rates and below.

The claim below is not an outlier.

This procedure will be performed at a hospital which has balanced billed our members in the past as they have not been willing to accept the plan’s RBP payment of 120% of Medicare.

But cash makes a difference. In this case they are accepting 105% of Medicare.

The date of service is 10/22/21. The price for the procedure comes out to 105% of Medicare for a Bilateral Aortagraphy/stent placement.

Agreed cash price: $8,237.67

Why more plans don’t implement a Cash Pay Option (CPO) is baffling.

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