Health Plans For State Employees Use Medicare’s Hammer On Hospital Bills

Jun 2019

The typical self-funded employer health plan using a BUCA (Blue, United, Cigna, Aetna) PPO is paying about 275% to 350% after the highly touted BUCA “discount” of 50% off gross billed charges of 550% to 700% of Medicare for any hospital procedure. Many states are now demanding to pay less — from 150% to 180% of Medicare to save millions by not overpaying.

Medxoom can help any employer health plan member pay less by knowing what their plan’s charges are before service so employees can go to lower price higher quality providers.

From NPR:

“States. They’re just as perplexed as the rest of us over the ever-rising cost of health care premiums.

Now some states — including Montana, North Carolina and Oregon — are moving to control costs of state employee health plans. Their strategy: Use Medicare reimbursement rates to recalibrate how they pay hospitals. If the gamble pays off, more private-sector employers could start doing the same thing.

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