“Our plan pays claims using Medicare as a benchmark plus a 50% bonus. In this instance that totals $1,350 for Joe Sixpak’s one hour emergency room visit” says the emaciated plan sponsor.
“Naw, we billed you 2,700% of Medicare! That comes out to $25,000” says the evil hospital administrator.
“Contestants, what are you going to do? You have 30 days to settle this claim dispute. If, at the end of 30 days you can’t come to an agreement, either of you can demand a baseball style binding arbitration process, winner take all. What do you want to do?” asks the game show moderator.
(Background clock ticking loudly counting down to decision deadline, soft elevator music)
“We are not going to pay such an egregious price!” screams the now pissed off plan sponsor. “This is outrageous!”
“We aren’t gonna accept such a measly amount when we can get more. You know it and we know it!” screams back the now frothing, evil, confident, all knowing and highly paid hospital administrator.
“Let’s go to arbitration!” yells the increasingly agitated hospital administrator as he slams his response button with his meaty gold fingered hand.
(Loud BUZZER sound reverberates across the studio)
“What are you going to do Mr. Plan Sponsor? The pricing difference is significant amounting to over $20,000. Baseball style arbitration means you pick a number, the evil, over confident hospital administrator picks a number, and an independent arbitrator decides either your number wins or the evil hospital’s number wins. Do you want to take that risk or accept the prize behind door number 2?” asks the debonair game show moderator. “We will return after the break. But first a word from our sponsor.”
“Good evening ladies and gentlemen. This show is brought to you courtesy of the No Surprises Act. Did you know that the American Hospital Association is a strong supporter of the No Surprises Act, applauding Congress for rejecting attempts to impose arbitrary rates on providers as well as to base rates on public payers, including Medicare and Medicaid. The No Surprises Act is intended to protect consumers from balance billing by shifting focus to the backs of plan sponsors” purrs the handsome Hollywood commentator. “Now back to our show.”
(Loud audience applause, Doc Severson band playing “Go Along To Get Along”)
“Welcome back. During the break our contestants have had a chance to negotiate a final settlement. Gentlemen, what are the results? asks the game show host.
“We offered to settle for 800% of Medicare but the offer has not been accepted yet” said the now smiling and over confident hospital administrator.
“Mr. plan sponsor, what is your decision? Do you accept the offer or risk entering into binding, baseball style arbitration where you may end up paying much more than the offer made here tonight? You have 30 seconds to make up your mind!” says the game show host.
(Loud ticking noise reverberates throughout the studio counting down to decision time while Helmut Zacharias and his singing violin plays ever so softly)
LOUD BUZZER
“Ladies and gentlemen, we’ve come to decision time. Does contestant #1, the plan sponsor, settle or does he roll the dice hoping for the best? Contestant #1, what is your decision” pants the now anxious and inquisitive game show host.
“What’s the prize behind Door #2?” pleads the still uncommitted plan sponsor.
(Background music dominated by heavy drum beating, increasing in volume, fills the studio)
“That’s it for tonight ladies and gentlemen. Tune in next week for the conclusion of tonight’s exciting show, Hospital Roulette! Will we learn what’s behind Door #2? Will contestant #1 agree ‘to Contestant #2’s settlement offer or will he roll the dice? asks the game show host. “What’s a one hour ER visit worth? We’ll find out. See you next week.”
