This single case agreement stipulates the plan sponsor will pay 85% of billed charges, whatever it ends up to be, no matter how much it is. Based on past experience we expect paid amount will be in the neighborhood of 600-1,000% of Medicare rates or more.
There are other M.D. Anderson facilities providing the same services at as much as half the cost or better with equal outcomes in quality and care.
The problem with this single case agreement is three fold: (1). Stop loss insurance may not cover the entire amount, (2). Sets a precedent by opening the door for other plan members wanting to access the same facility using other people’s money, (3). Other hospitals will take note of this and view the plan sponsor as an easy mark worth squeezing.
“You reimbursed Plan Member Jones 1,000% of Medicare but you will only reimburse Plan Member Garcia 120% of Medicare! That’s discrimination!” shouts the attorney.
M.D. Anderson is a state owned hospital system in Texas.