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Health Plans: Is It Time to Bring Back 'Reasonable and Customary'?
Chelko Center for Benefits Management Link to more items from this source
[Opinion]
May 1, 2018

"Since billed charges are no longer reasonable and their payment no longer customary, TPAs started tapping into these blind networks to limit non-network payment levels. And since some of these were already set up as shared savings arrangements, a new revenue model was born. How much revenue? When we can see it (it's often hidden in claims data), it has usually amounted to about 10% to 20% of administration fees -- not a bad source of added revenue!"

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