🙏 Cigna ER Analysis Updated - Thank you LinkedIn Network! 💡Split Analysis between Professional vs Institutional Rates 👉Prof = Up to 58 X Medicare, Inst = Up to 95 X Medicare
I dunno... I gotta think there are data errors here. There is no way they're paying 9,500% of Medicare. You'd put the facility demanding that reimbursement level out of network and pay them a rock-bottom MultiPlan rate. Even 1,000% of Medicare seems unrealistic. I don't doubt you are accurately representing what the file says, and that Cigna is required to report accurate data. An interesting data point is that IDR resolutions have been averaging 370% of Medicare, or 50% higher than historical mean in-network rates. So maybe a payer would contract with a problem facility at say 400% of Medicare if they thought getting prior auth/record review/fixed fee schedule/etc. was worth a bit extra than the OON rate. But not 1,000%... https://www.brookings.edu/articles/a-first-look-at-outcomes-under-the-no-surprises-act-arbitration-process/
Please elaborate on why CIGNA published this/ for the purpose of who, to do exactly what; realtive to CEO or Broker Decision-making for an Employer's 2025 Group PPO In-network Health Plan Benefits for covered Employees : Otherwise a meaningless Post?
Brian, this is great information. Is each circle a facility or a individual practitioner or a combination of both? The spread on page 2 is staggering. Stay in network they said....
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2moHere's a screenshot of the RAW data. It's actually 2 screenshots stitched together to show CPT Code 99281 for Institutional and then the listed rate of $8,050.00. There are so many rates I couldn't fit them in a single screenshot. Let me know if there's other data you'd like to see.