A PPO health plan is built around a “preferred provider” network that offers a discounted rate to members that use the healthcare services of their contracted providers. The problem is that the PPO discount that is included in the plan is typically applied to a highly inflated rate.
Take a CT scan, for example. The average price for a hospital CT scan in the U.S. is $3,821. A typical PPO plan provides a 60% discount, which lowers the price to $1,528. That sounds like a good deal until you realize the actual cost of the CT scan, as reported by the facility, is only $100. That’s a 3,800% markup!
With an Imagine360 plan, we take a different approach to pricing claims. In the CT scan example, our members get the CT scan at the same hospital. But instead of paying the full amount, Imagine360 reviews and reprices the claim, using the actual cost of care ($100) and what Medicare pays ($125) as a guide. It then resubmits the claim with payment. So instead of paying $1,528, an Imagine360 member pays just $150. That’s significant savings compared to a traditional PPO plan. Same procedure. Same hospital. Dramatically lower cost.
And if the provider ever has a question about payment, you have a team of member advocates on your side to help resolve any billing issues and further maximize those healthcare savings. That’s the advantage of an Imagine360 health plan solution versus a PPO.