Managed care contracts have been clouded in mystery for years, contents of which have been jealously guarded by gag clauses and tight lipped industry insiders. But no more.
These one sided agreements contain a whole lot of Gotchas. The biggest Gotcha of all will curl your toenails and singe your eyebrows.
CAUTION: To avoid the aforementioned effects discontinue reading. Do not cross the line below. Otherwise, if you’re hell bent on self-flagellation, we suggest you invite Jose Cuervo to read along with you.
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Ok, ready brave one? Here is the toenail curling, eyebrow singing GOTCHA:
Once hospital billed charges total $100,000 (pick a number) the PPO allowed amount increases by up to 1,000% or more. In other words, you get what PPO’s tout with a wink and a grin as “deep discounts” on small claims but you get hosed with a wink and a grin on the big ones.
Here’s an example: Billed Charges total $99,999.99. This is the equivalent of 600% of what Medicare would pay. The PPO discount equals 50% or about $45,000 which leaves a balance which equals to about 300% of what Medicare would pay. But if the total billed charges are 1 cent more in this brilliant example the reimbursement rate reverts to 5-10% off billed charges which means the allowed amount is increased to as much as 100% bringing the total PPO allowed to the equivalent of 550% or more of what Medicare would pay.
A hospital bill of $100,000 can accrue faster than a speeding bullet, is more powerful than a locomotive, and “Look Lois, it’s as high as that plane!, it’s a hospital flipping the bird, it’s, it’s, a turbocharged hospital bill!”
