The Rhoads Insurance Group loves helping families save money, with health insurance as well. That’s why we work with the Multiplan PPO network plans.


What is the Reading Multiplan Network?

Reading Multiplan started in the 1980’s as a regional NY hospital network, and has grown to be the largest PPO in the US, with over a million healthcare providers in network. They’ve grown so much because of the value that they provide to both insurance companies and to consumers. With payment integrity, they help insurers reduce the cost of care, which those insurers pass along to consumers with more competitive rates vs benefits. And with a flexible network structure, covering all specialties in the entire United States, this PPO truly makes healthcare flexible.


A Better Reference for Pricing

There is a growing trend among health insurers to base reimbursement for claims on Medicare reimbursement rates, under the name of Reference-Based Pricing. The problem is, Medicare is not only a flawed valuation for many healthcare services, but it also can deliver unintended consequences. The better measure is one that more directly ties to a doctor’s or hospital’s own costs.


Extending the Power of Bill Review

Reading Multiplan uses analytics tuned to find wasteful or abusive medical billing practices not identifiable by more automated bill review programs, and implements resolution strategies. That means that when you go to a doctor who is in-network, you can trust that you’re not being over-billed; every in-network doctor has had their billing practices reviewed before joining the network. And it also means that for every medical bill, there is a negotiating team in place.

Let’s see an example:

A spinal fusion procedure billed at $42,452 was reduced by bill review to $24,956. Payment integrity analysis determined that a spinal fusion and lumbar laminectomy were separately billed. Citing CPT Assistant, American Association of Neurosurgeons and the NCCI manual, the lumbar laminectomy is included in the spinal fusion if performed at the same spinal level, and is only as extensive as necessary to prepare the site for the fusion.

After discussion with the provider, the bill was reduced, with provider signoff, by an additional $5,852.


How this affects you

Reading Multiplan is a PPO network that many insurance plans can use for their healthcare payer services. That means that this great network fosters even more competition – there are many plans out there that work on this network, all getting cost-reducing benefits from the network, and all vying to earn your business by passing on those savings.

Contact me today to hear more about the options we can provide at the Rhoads Insurance Group.