Value Based Fee System – Aetna Vs Weslaco Independent School District

“The contract between Aetna and Weslaco Independent School District provided that Aetna would be compensated by a Value Based Fee System (schedule) wherein Aetna would retain 9.7% of the difference between the billed charges and negotiated (PPO)rate.”

http://www.13thcoa.courts.state.tx.us/opinions/pdfOpinion.asp?OpinionID=20133

Editor’s Note: This is further evidence that not all PPO “discounts” are passed on to the consumer. Revenue sharing with providers can be lucrative. If billed charges for Weslaco ISD for the year were $17,000,000, and “negotiated” rates brought that down to $9,000,000, Aetna’s fees in this fabricated example would have been $776,000.

See http://blog.riskmanagers.us/?p=6040

Comments are closed.