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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
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$2,481
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$5,790
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70%
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| HOSPITAL STAY & SURGERY |
$10,588 |
$1,950 |
$8,638 |
82% |
| HOSPITAL STAY |
$7,248
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$1,850
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$5,398
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74%
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| 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) |
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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%.
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| Cost & Benefit Details |
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$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.
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info@unitedhealthbenefits.com ~ 1-866-990-6789 ~ 757-592-9163 ~ Newport News, Virginia
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