Group Medical Plan with Provider Reimbursement Rate of 120% of Medicare

[toddoxley]

One of my groups gave me a quote ( large group) that another agent gave them with a $119.00 ee rate. In the fine print it stated that the provider reimbursement rate was an amount equal to 120% of the Medicare fee schedule. No Insurance carrier information on the quote.

Has anyone ran into this type of a plan yet ?

 

[leevena]

Yes, 20 or so groups written with this. Use a hybrid network, meaning a professional network but no hospital network. Each is self funded. Is there something specific you want to know?

 

[toddoxley]

Yes, 20 or so groups written with this. Use a hybrid network, meaning a professional network but no hospital network. Each is self funded. Is there something specific you want to know?

How about who is the insurance company. How is it working for your clients? Any renewal history?

With no Hospital network has anyone had a hospital claim and how did the % above Medicare charges work out? Balance billing ?

Thanks in advance for any info you can provide.

 

[leevena]

Bear with me, sitting in coffee shop early in the morning and I do not have all my info.

Most groups are self funded through Gerber, but that is irrelevant, the carrier has little to no input nor does it care. We have seen the discount raised by 45% and as a result our claim cost has decreased substantially.

Many hospital bills, we are talking about 20 groups with thousands of members. Some push backs from hospitals, but nothing problematic...yet. Balance billing is a potential, but nothing yet.