You’re Fired!

You’re negotiation skills suck!

A Reference Based Pricing plan in Texas benchmarks and pays claims at 125% of Medicare. A nationally known, low cost, RBR vendor performs the re-pricing and, among other services,  provides balance billing representation/negotiation.

Below are the results of the (low cost) vendor’s balance billing negotiation on a recent claim:

Billed Amount: $39,227.99
Plan Allowable (125% of Medicare): $1,591.45
Plan Payment: $1,370.86
Orig. Balance Bill Amount: $37,636.54
Discount Applied: $24,364.44
Additional Payment: $13,272.10
Total Payment (Plan Allowable + Additional Payment): $14,642.96
% of Medicare: 1167.45% (apx)

The plan would have been better off with a PPO network in this instance.

“If quality isn’t a variable, then price shouldn’t be a variable. However, in truth, we are aware that the bitterness of poor quality often remains long after the sweetness of low price is forgotten” – Quote Stolen From (unknown) Others