Out-Of-Network BUCA Reimbursement Revealed

One of our clients recently went out to bid for their fully-insured group medical plan. Most of the BUCA’s bid on this case, clearly indicating there is competition for this account which generates a seven figure revenue stream.

Two of the BUCA’s, independent of each other, disclosed their out-of-network reimbursment strategy:

BUCA #1 pays 110% RBRVS for facility and professional services while BUCA #2 pays 105% RBRVS for professional services and a whopping 140% RBRVS for facility charges.

So the question arises – do these two BUCAS pay providers more  or less out-of-network compared to in-network? If the answer is “more” than in-network providers are really stupid. If the answer is “less” than those “steep” in-network provider discounts are nothing to write home about.