Lies You Believe (Part 9)

Lies You Believe (Part 9)

Hello! Dr. Keith Smith and Jay Kempton, both here on behalf of the Free Market Medical Association. Let’s talk a little bit about repricing of claims.

What I’m talking about is when your employers see that your network and your TPA are the same entity. Jay, take it from there. Tell us about how this scam works and all the various places they can rob these employers.

Jay: If you are in the situation where your TPA also has a network, they have control over both sides of that arrangement. What happens is, when that bill comes in, they discount that amount and the amount that they pay to the medical provider is less than the amount debited to the employers account. This provides margin, or skim, that the TPA can retain. This is undisclosed or is disclosed in an unquantifiable way, and is under a shared savings model which is based on fiction.

Keith: There might be shared savings arrangements that are exercised by this ASO network in addition to the skim you’ve just described, is that right?

Jay: Absolutely, they may be getting paid by the medical provider for volume that is coming to them. Ultimately that payment is being derived from the employer.

Keith: I always wonder why, with the quality that we have at the Surgery Center of Oklahoma and our pricing in many providers all over the country that are embracing free market health care, that the carriers, the PPOs and the ASOs are not crawling up to them. It’s because transparent free market bundled pricing denies them all the opportunities to rob you employers.

Employers, wake up and know that you are being lied to. Thank you for joining us.