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August 18, 2002 at 08:00 PM
HealthMarket Inc., Norwalk, Conn., is one of the companies in the defined-contribution health plan market that is serious about persuading consumers to bargain with their doctors.
When a plan encourages plan members to bargain, “some of the patients are very aggressive negotiators,” says Dr. Hassan Rifaat, HealthMarkets vice president of sales.
HealthMarket, like most of its competitors, offers programs that combine catastrophic health insurance with employer-funded health reimbursement accounts. The cash in the HRAs is supposed to cover the cost of workers ordinary medical expenses.
Many defined-contribution programs give workers complete control over HRA cash.
HealthMarket is following a different strategy.
HealthMarket rents provider networks organized by Private Healthcare Systems Inc., Waltham, Mass., then determines what each of the network providers in a given market actually charges for selected services.
HealthMarket comes up with a “maximum allowable charge,” or MAC, set so that 70% of the providers in a market charge less than the MAC.
