I was wondering if someone could help me clarify a few quick questions I had about private insurer bargaining? In particular,
- Do they bargain with each provider 1 time, or when they bargain, do they bargain for separate contracts for each plan (e.g. HMO, PPO, etc.) Like, if I'm a doctor, will the insurer go up to me and be like, "hey let's set the prices that you'll get for my HMO plan. Ok, great, so we agreed to 150% of the Medicare Physician Fee Schedule MPFS rate for the HMO plan, and 30% of it for the copay. Alright, next let's negotiate PPO plan. Ok, so we agree to 110% of the MPFS rate for the PPO plan and 50% of the MPFS rate for the copay.
- Did any of this significantly change during COVID?
- This is the same under Medicare part C as for non-Medicare part C, right?
- Do they bargain with each provider 1 time, or when they bargain, do they bargain for separate contracts for each plan (e.g. HMO, PPO, etc.) Like, if I'm a doctor, will the insurer go up to me and be like, "hey let's set the prices that you'll get for my HMO plan. Ok, great, so we agreed to 150% of the Medicare Physician Fee Schedule MPFS rate for the HMO plan, and 30% of it for the copay. Alright, next let's negotiate PPO plan. Ok, so we agree to 110% of the MPFS rate for the PPO plan and 50% of the MPFS rate for the copay.
- Did any of this significantly change during COVID?
- This is the same under Medicare part C as for non-Medicare part C, right?