TPA Markets Medicare Plus Reimbursment Plan

This is another example of a TPA moving away from managed care contracts and reimbursing providers using Medicare pricing as a claim benchmark.

Plan pays 125% of Medicare. Plan participants can log in on their smart phone while at the providers office and key in the procedure code. “Excuse me nurse, what is the procedure code for that lab test you want me to take? Oh, $500 you say? Well, my plan will pay $200 for that test, will you accept that as payment in full?

That will beĀ  almost like in the old days, around 1966 when I twisted my leg while in pole vaulting practice. My mother took me to the doctor and before any treatment was tendered, my mother asked “What will this cost?” A simple, direct question. “It will be $15.” Ok, I can afford that, will you take a check?”