Cash Pay Centric Health Plan Model
A 400 life case implemented a Cash Pay Centric Plan effective January 1, 2021. To date results have been good.
These were on today’s claim run:
| Procedure (CPT or DRG) | Medicare Price | Cash Price | % of Medicare |
| 66984×1 | $2,079.16 | $1,250.00 | 60% |
| Procedure (CPT or DRG) | Medicare Price | Cash Price | % of Medicare |
| 66984×1, 65820×1, 66174×1 | $3,917.74 | $2,860.00 | 73% |
| Procedure (CPT or DRG) | Medicare Price | Cash Price | % of Medicare |
| 43239×1, 45378×1 | $1,206.43 | $723.31 | 59% |
| 00731×1 | $300.00 | $300.00 | 100% |
| Procedure (CPT or DRG) | Medicare Price | Cash Price | % of Medicare |
| 45378×1, 43239×1 | $1,206.43 | $723.31 | 59% |
| Procedure (CPT or DRG) | Medicare Price | Cash Price | % of Medicare |
| 97116×1 | $117.76 | $100.00 | 84% |
These claims in the aggregate represent 67.51% of Medicare. The patients paid nothing.
Patients save, the plan saves, and the providers get paid on the date of service, in full and don’t have to chase money or file claims.
Everyone wins. Everyone is happy.
Meanwhile managed care plans are paying much more for the same services while bitching about the high cost of health care at the same time. Providers end up chasing money, patients bitch and moan about deductibles, co-insurance and balance billing disputes.
No one is happy.
RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.
