Here are five highlights from the publication’s analysis of explanations of benefits from UMMC patients:
1. Under UMMC’s agreement with the BCBS-administered State and School Employees’ Health Insurance Plan, the health insurer pays only 13 percent of the $4,328 fee, compared to UnitedHealthcare’s 100 percent.
2. The bills shed light on the massive discrepancies in reimbursement rates that providers and payers agree to behind closed doors. According to the explanation of benefits obtained by the Clarion Ledger, UnitedHealthcare appears to receive no discount on Level 4 ER facility fees, while BCBS, the state’s largest insurer, gets an 88 percent discount for its state health plan.
3. In comparison, the bills show Cigna receives a 42 percent discount, agreeing to pay $2,500 for the ER fee. Medicare would have paid $355.53.
4. At the same time, UMMC has increased its ER facility fees 175 percent in two years. In 2015, its Level 4 facility fee was $1,744, and today is up to more than $4,796, according to the Clarion Ledger. UMMC said it has to keep inflating its chargemaster to get incremental increases in reimbursement from payers like BCBS.
5. UMMC and BCBS are currently mediating their contract. The hospital claims BCBS pays too little for services, while BCBS has argued the medical center wants to be treated differently than other area providers. Both organizations agreed to not “engage with media” during their negotiations, according to the report. Mediation was set to end Aug. 1, but has since been extended.
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