Examples of "PPO" Network Savings
*Pre-negotiated, Contracted Rates*
 Important Information
*EXAMPLES OF ACTUAL FEES AND PPO ADJUSTMENTS ACHIEVED BY MEMBERS ACCESSING PARTICIPATING PPO CONTRACTED NETWORKS. Pre-Negotiated Contracted Rates Made Avaliable Through A Network PPO. "Usual and Customary"
(DOES NOT INCLUDE INSURANCE BENEFITS FOR ADDITIONAL SAVINGS)

 Treatment Description Usual Fee Member Paid  Savings %Saved
ECHO TRANSTH DUR REST & STRESS W/INT & REPORT  $910 $189 $721  79% 
CV STRESS TEST W/ TREADMILL INTERPT. & REPORT $635  $382  $253  40% 
SPIROMETRY W/RECRD-TOT & TIMED VC-EXPIR FLO RATE $101  $48  $53   52% 
REMOVE SKIN TAGS ANY AREA: TO & INCL 15 LESS $133  $61  $72   54% 
COLONOSCOPY FLEX-PROX SPLEM FLEX: DX (SEP PRO) $975  $412  $558   57% 
ECHO BREAST (S) SCAN B-SCAN &/OR REAL TIME W/IMAGE  $480 $112  $368   77% 
ARTHROPLASTY TMJ W/PROSTH JT REPLAC $9,785  $2,135  $7,650   78% 
OFFICE /OUTPT VISIT MOD-HI SEVERITY 25 MIN. $100  $60  $40  40% 
OFFICE /OUTPT VISIT LOW-MOD SEVERITY 15 MIN. $55  $34  $21  38% 
MAMMOGRAM $162  $95  $67  41% 
MRI $1,048  $626  $422  40% 
HOSPITAL STAY & SURGERY $11,199  $1,250  $9,949   89% 
HOSPITAL STAY & SURGERY $15,791   $5,527   $10,264   65% 
HOSPITAL STAY $7,346   $2,204  $5,142  70% 
HOSPITAL STAY $1,663   $600   $1,063  64% 
HOSPITAL STAY & SURGERY

 $8,271

 $2,481

 $5,790 

  70%

HOSPITAL STAY & SURGERY   $10,588       $1,950     $8,638    82%
HOSPITAL STAY 

 $7,248

 $1,850

 $5,398 

 74%

 UHB in Action - A Real Life Scenario
Example: A gentleman in Fort Worth, Texas with the UHB Platinum Plan.
He had a major heart attack costing: $46,000.00 (red = his cost)
(blue = UHB membership benefit)

He was admitted with no problem, because the UHB card of membership contains insured benefits. The laws states "NO HOSPITAL CAN DISCRIMINATE AGAINST ANYONE'S INSURANCE PLAN".

He was taken into ICU/ CCU (coronary care unit) and was treated.

With the UHB, he has a $20,000.00 Critical Care Benefit for ICU/CCU that pay's $1,000.00 a day, with no deductible. (This benefit can be used multiple times a year for each family member).

His bill was reduced to $14,720.00 due to the "pre-negotiated contracted rate". PPO savings.

He was in CCU for 5 days. That equates to $5,000.00 of coverage. (Remember, CCU/ICU pays $1,000.00/ a day, per family member, multiple times per year, no deductible. 

He received the $500.00 indemnity per day for each day in the hospital for 5 days. (This was on top of what his UHB card already did for him.) 

Plus he saves more on maintenance medication from the pharmacy, up to 86%.

Cost & Benefit Details

$46,000.00 Initial cost
-$31,280.00 Reduced, (pre-negotiated contracted rate PPO).
$14,720.00 Balance left to pay, however;
-$5,000.00 $1,000.00/day X 5 days in CCU
$9,720.00 Balance left to pay however;
-$2500.00 $500.00/day X 5 days in the hospital
$7,220.00 Balance left to pay, however;

(We are not including how much he saved on maintenance medication)

Total patient responsibility after a $46,000.00 heart attack was
$7,220.00.

This client had the 07' Platinum Plan that cost him $184.95 per month or $2,219.40 for the year. If you compare that to a traditional major medical plan he would have been paying around $5,592.00 per year. That is $3,373.00 more a year than his UHB plan. If he had a major medical he would have been out of pocket for this hospital stay around $6,000.00 compared to the $7,220.00 but would have paid $3,373.00 more per year for it. What he saved in 1 year of payments more than paid for the difference of his out of pocket expense.

 

 

info@unitedhealthbenefits.com ~ 1-866-990-6789 ~ 757-592-9163 ~ Newport News, Virginia

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