"Our member needed high-stakes surgery. The hospital knew it. The family knew it. Surgery was on the calendar; pre-op scans and imaging needed to be done. The message from the hospital was essentially: pay our inflated price, or the whole thing is at risk. When our repricer hit their bill with the 140%-of-Medicare logic, we weren't even in the same galaxy as their demand. They wanted ten times that amount. They wanted something no rational fiduciary could sign off on under ERISA's command to guard plan assets prudently."  MORE >>