Health care consumer reacts to shocking revelation
Wikileaks has released a purloined email today in response to Mulebriar’s interview with Julian Assange earlier this week (Wikileaks Releases Mulebriar Transcripts – Part One). In an email dated 2011 to RiskManagers.us, Mulebriar expresses shock and amazement that PPO contracts may not always pass on the full “discount” to consumers. She asks, “Are 100% of PPO discounts passed on to the consumer? In this case, the answer is no.”
Below is the redacted, purloined 2011 email published by Wikileaks this afternoon:
Bill, are 100% of PPO discounts passed on to the consumer? In this case, the answer is no.”
Below is the wording in the PPO contact we discussed. If all the employers nationwide really understood how corrupt PPO’s are we would have a revolt. This TPA is throwing out $8 admin fees on 150 life groups, yet they could be making $200 PEPM on the discount differential model below.
It is amazing that we pulled several quotes from XYZ Insurance Company and other national carriers from 1999 to 2003. The average admin fee was around $50. Now they are coming in around $30 and below. Looking at the financials of these carriers their expenses have gone up just like all other companies nationwide, yet their admin fees have almost gone down 50%. Are employers really that gullible? I guess so.
Here is the actual wording we found in the contract:
“In addition, Client hereby acknowledges that, as a part of PPOs contractual arrangement with certain participating network providers, PPO and its Affiliates may receive compensation for administrative services performed for the benefit of Participating Providers during the term of this Agreement. Such fees may be in the form of direct payment by the Participating Provider to the PPO or in the form of a differential in reimbursement amounts (the “Differential Model”).
“In a Differential Model scenario, the reimbursement amount paid for a claim under this Agreement may not be identical to the amount of compensation a Participating Provider receives or retains in connection with providing health are services.”
“Client acknowledges, subject to the requirements of applicable law, that reimbursement amounts paid to Participating Providers under this Agreement may not be identical to the amount of compensation a Participating Provider receives or retains. Solely PPO and Participating Provider establish the applicable reimbursement amount in the Differential Model, and the compensation which PPO and Affiliates shall be paid, which shall be fair market value for services rendered.”
“Neither Client nor any Customer of Client shall be entitled to any portion of such administrative fees paid by a Participating Provider.”
This is amazing information. Which law firm do you think will grab this and run with it? The tobacco settlement will end up looking like child’s play – Molly
Editor’s Note: We have not confirmed Wikileaks is involved in this email release or if it even happened. One of our three readers, a usually reliable source when sober, offered his unsolicited opinion during our monthly wine and cheese party this afternoon, “Bill, I swear this is true. But you won’t find this in the New York Times or in any other main stream media. The health care industry is one of media’s biggest advertisers, enormous amounts of money involved. You better get someone to start your car in the mornings from now on! Molly too! BTW, when did you switch from beer to wine?