PPO’s Are Dying

PPOs are Dying – Why Pay for One?…………….Do you pay for a grocery store network…………?

Bill Hennessey, M.D.

Bill Hennessey, M.D.CEO at Pratter, Inc.10h

PPOs are Dying – Why Pay for One? Pratter has proven time and time again that 20% to 30% savings is available for routine medical care including blood work, imaging and surgery center procedures. In-network pricing for the same care fleeces a company out of that much money.

And then we get asked the following: “So do you measure quality?” Answer: your carrier TPA has vetted all medical providers in your network. We don’t get paid to do that.”

The above is met with either a) a snicker or b) a belly laugh. Until now, I have refrained from saying “you are laughing at the person in the mirror.”

You make your company pay $30 PEPM for a network that you admit you laugh at – no quality you rely on and it makes you pay 30% too much for care – ouch! Right now, I am willing to charge those that laugh at the quality parameters of a carrier PPO network “only” $20 PEPM for our service – a full $10 less than the carriers – and we will reveal the claim allowable prices wherever possible.

Okay – I am exaggerating our fee for service but it’s a huge bargain compared to typical PPOs as they strive to keep the most expensive providers in-network. Carriers have a fiduciary to their investors – not employers. Do you pay for a grocery store network?