If plan members knew the truth about health care financing they would be some kind of pissed off……………
A large self-funded group plan seeking competitive health insurance proposals wants to continue accessing a managed care network, i.e, a PPO plan.
A BUCA, in partnership with an independent TPA, is offering access to their network for about $16 pepm. Based on the size of this group, total network access fees will be almost $1.5 million per year.
The BUCA stands to earn even more by working the spread which can be as much as 10%. This fee is hidden on the claim side of the ledger and never disclosed to the plan sponsor.
RECAP: This group will be paying $1.5 million for the privilege of accessing managed care contracts they can’t see nor audit and will unknowingly give up part of the PPO “discount” representing millions more. But plan members will be happy because all of their doctors and hospitals are “in-network” when they don’t have to be.