Texas Hospitals bill 260% more than Medicare allowable, on average….raises eyebrows with Employers who purchase insurance/benefits.

The latest RAND study on what hospitals are charging private health plans vs. what Medicare pays them for the same services is getting a lot of attention, and not in a good way. That is, if you’re a hospital.

We’ve been saying for several years that the gulf between what private plans are paying providers compared to what Medicare pays was getting bigger, and this study confirms it. Self-funded employers should sit up and take notice of the widening gulf and then do things to address it, starting with knowing what you are paying for healthcare services.

We can no longer afford to passively manage the healthcare supply chain year by year. We must begin to be far more proactive in the management of healthcare dollars and clinical services.

Just this morning I had a client’s employee send us an Emergency Room bill. This man had slipped on a wet floor, fell into a stair case, and cut the bridge of his nose open. He went to the ER, and did not require stitches or anything. However, the hospital did proceed to send him for two x-rays, and a CT scan, and the total bill is over $25,000.

Even with generous “network discounts”, this bill will be over $9000 when it is all said and done. A bill that should be less than $2500. If Medicare was the payor, it would be less than $1000. So why the variance? Read the reports and you’ll see that many of the arguments for such variance are being proven false.

As payors of our healthcare, we deserve more transparency in healthcare.