For decades we’ve all been focused on PPO and HMO Networks. Which one has the best discounts, which one has the most providers, which one works best for each of us. Which one requires a certain amount of steerage between network and non-network, how they may or may not coexist with each other, and what sort of disruption it may cause for employees when change occurs.
Networks have been the center of attention for employers, employees, brokers and consultants because that is what the insurance world has “sold” us on. One network is bigger and better than the next – and everyone has believed it.
Think about this crazy circle between the parties: Insurance companies want bigger discounts from providers so they can be more competitive and sell their plans to employers; health care providers raise their prices to offset the discounts they give insurance companies; insurance companies convince brokers and consultants to sell their PPO insurance plans to employers and pay them big bonuses and commissions; employers continue to cost shift to employees to offset the increasing prices, and employees are stuck with higher monthly contributions as well as higher out of pocket expenses when they go to a provider.
Negotiated discounts by insurance companies are not disclosed to anyone, nor are the prices providers charge or how often they are increased. Total compensation paid to brokers and consultants is usually not fully disclosed, even though it’s paid by the employer through premiums or other administrative charges.
At the end of the day, who is working for employers and employees to lower costs? Certainly not brokers or consultants who get paid a lot of money to sell insurance company plans. Certainly not the insurance companies who continue to raise premiums and answer to Wall Street with record profits, and certainly not medical providers who keep their prices hidden and raise them whenever they want.
PPO Networks are the travel agents for the hospitals and other medical providers, and the brokers and consultants are “selling the vacation.”
Watch this video from 60 Minutes a few weeks ago.
There is a better way: eliminate the PPO contracts with medical providers and simply pay them based upon a fair and reasonable method that ensures them a reasonable profit – and let employees go to whatever provider they want to throughout the U.S. – because there isn’t any network!
Additionally, when you eliminate the PPO network you can also eliminate Out-Of-Network benefits. Everything – all charges are paid at the In-Network level – which makes employees very happy.
Turn 2021 into something special for your employees and your bottom line. Get rid of the word “Network” out of your vocabulary.
If you want to learn how to do just that, email me at [email protected] or call me at 970-349-7707 and we can chat. Happy New Year!