Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management, recommends hospitals and other providers ask payors these four questions regarding benefit plan incentives within managed care contracts during negotiations.
1. Are incentives to use the PPO included in the health benefit design?
2. Are incentives to use the PPO greater than 10 percent?
3. Does the benefit plan accompany the contract to evaluate incentive package, non-covered services and plan competitiveness?
4. Are there outpatient or second surgical opinion requirements? If yes, are they reasonable?
1. Are incentives to use the PPO included in the health benefit design?
2. Are incentives to use the PPO greater than 10 percent?
3. Does the benefit plan accompany the contract to evaluate incentive package, non-covered services and plan competitiveness?
4. Are there outpatient or second surgical opinion requirements? If yes, are they reasonable?
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