Interesting stuff! Can you explain why MA plans pay more than Medicare FFS for Dialysis? I thought that MA plans usually just paid the FFS rates for provider services. I was able to find this, but it doesn't answer the question of why the facilities are able to negotiate higher rates and stay in-network...
"In an interesting twist, providers can charge more in the Medicare Advantage market by being in network. If a patient goes to an out-of-network provider, the provider is prohibited from charging more than traditional Medicare,” said Erin Duffy, research scientist at the USC Schaeffer Center. “But when there are only one or two providers in a market, the insurance company loses any potential leverage to negotiate lower payments.”
This is such a great summary, thanks @thepostop and @Tim F. for sharing
Interesting stuff! Can you explain why MA plans pay more than Medicare FFS for Dialysis? I thought that MA plans usually just paid the FFS rates for provider services. I was able to find this, but it doesn't answer the question of why the facilities are able to negotiate higher rates and stay in-network...
"In an interesting twist, providers can charge more in the Medicare Advantage market by being in network. If a patient goes to an out-of-network provider, the provider is prohibited from charging more than traditional Medicare,” said Erin Duffy, research scientist at the USC Schaeffer Center. “But when there are only one or two providers in a market, the insurance company loses any potential leverage to negotiate lower payments.”