Self-funded plan sponsors should conduct a study of local hospital pricing. Most haven’t. Why?
Cuero Community Hospital is a small rural hospital located in Cuero, Texas. A visit to their website provides information on their negotiated pricing with the major carriers as well as rental networks such as Beechstreet, Galaxy and others.
A visit will give the reader an idea of the difference between billed charges, PPO allowed charges, and cash pricing.
A random view of pricing indicates the BUCA’s get a substantially better deal than the rental networks. All the BUCA negotiated pricing is about equal and is approximately 60% of billed charges. The rentals, on the other hand, average about 85-90% of billed charges.
Why would a plan sponsor use a rental network at this hospital? This reminds me of flying on Southwest Airlines and asking all the passengers around you what they paid for their ticket. You won’t be surprised some pay more than others.
Another pricing example, CPT 99285, shows Humana, Cigna, Aetna & Blue Cross allowable is about 253% of Medicare. CPT code 99285 is: “Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.”
Cash prices are about 20% off BUCA average allowed amounts.
From Cuero Hospital Website:
The prices available on this site are the actual prices that we have negotiated with insurance providers for their members and the cash prices we offer to all our patients. If you are paying through your insurance, the listed price will be charged to them and they will pass on none, some, or all of those charges to you based on your plan details and year to date spending.
Price List – Cuero Regional Hospital
Cuero Community Hospital – Machine Readable Page (adobecqms.net)
For individuals who do not have insurance, carry out-of-network insurance, or who receive services their insurance does not cover:
- Cuero Regional Hospital offers a variety of financial assistance programs, including charity care and discounts for uninsured individuals.
Click Here to download a financial assistance application.
Click Here to download a hospital indigent application.
