TRS ActiveCare Announces New Premium / Benefit Changes

TRS ActiveCare Board of Trustees have approved rates and benefits for the 2010-11 Plan Year. This program provides health care benefits for Texas School District employees and is administered by Blue Cross & Blue Shield.

Rates are to be increased approximately 7%. There are minor benefit changes to be implemented.

Of interest is the payment methodology to be changed for “Allowable Amount for non-contracted provider services”. Currently that method is “determined by Blue Cross & Blue Shield of Texas”. Under the new Plan Year benefits, non-contracted providers (non-PPO) will be reimbursed at “50% of the non-contracted provider’s billed charges.”

Does this mean if Dr. Smith bills $1000 and Dr. Jones bills $1,200 for the same service, does Dr. Jones will get more for his work than Dr. Smith gets?