A few minutes ago I reviewed a 440 facility claim run on a school district. This information is not the type of information a plan sponsor will ever get from a BUCA. And, you will not find many TPA’s providing this information either.
# Claims = 440
Average Gross Billed Charges as a % of Medicare = 600%
Average PPO Allowed as a % of Medicare = 487%
Total Allowed PPO Charges on 440 claims = $10.6 million
Total Allowed @ 135% of Medicare = $2.9 million
If plan sponsors had this information they would realize they are over paying for health care through secretive managed care contracts they are not allowed to see or examine.
Molly Mulebriar
