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| Important Information | | *EXAMPLES OF ACTUAL FEES AND PPO ADJUSTMENTS ACHIEVED BY MEMBERS ACCESSING PARTICIPATING PPO CONTRACTED NETWORKS. Pre-Negotiated Contracted Rates Made Avaliable Through A Network PPO. "Usual and Customary" | | (DOES NOT INCLUDE INSURANCE BENEFITS FOR ADDITIONAL SAVINGS) |
| Treatment Description | Usual Fee | Member Paid | Savings | %Saved | | ECHO TRANSTH DUR REST & STRESS W/INT & REPORT | $910 | $189 | $721 | 79% | | CV STRESS TEST W/ TREADMILL INTERPT. & REPORT | $635 | $382 | $253 | 40% | | SPIROMETRY W/RECRD-TOT & TIMED VC-EXPIR FLO RATE | $101 | $48 | $53 | 52% | | REMOVE SKIN TAGS ANY AREA: TO & INCL 15 LESS | $133 | $61 | $72 | 54% | | COLONOSCOPY FLEX-PROX SPLEM FLEX: DX (SEP PRO) | $975 | $412 | $558 | 57% | | ECHO BREAST (S) SCAN B-SCAN &/OR REAL TIME W/IMAGE | $480 | $112 | $368 | 77% | | ARTHROPLASTY TMJ W/PROSTH JT REPLAC | $9,785 | $2,135 | $7,650 | 78% | | OFFICE /OUTPT VISIT MOD-HI SEVERITY 25 MIN. | $100 | $60 | $40 | 40% | | OFFICE /OUTPT VISIT LOW-MOD SEVERITY 15 MIN. | $55 | $34 | $21 | 38% | | MAMMOGRAM | $162 | $95 | $67 | 41% | | MRI | $1,048 | $626 | $422 | 40% | | HOSPITAL STAY & SURGERY | $11,199 | $1,250 | $9,949 | 89% | | HOSPITAL STAY & SURGERY | $15,791 | $5,527 | $10,264 | 65% | | HOSPITAL STAY | $7,346 | $2,204 | $5,142 | 70% | | HOSPITAL STAY | $1,663 | $600 | $1,063 | 64% | | HOSPITAL STAY & SURGERY | $8,271 | $2,481 | $5,790 | 70% | | HOSPITAL STAY & SURGERY | $10,588 | $1,950 | $8,638 | 82% | | HOSPITAL STAY | $7,248 | $1,850 | $5,398 | 74% |
| UHB in Action - A Real Life Scenario | | Example: A gentleman in Fort Worth, Texas with the UHB Platinum Plan. | He had a major heart attack costing: $46,000.00 (red = his cost)
(blue = UHB membership benefit) | He was admitted with no problem, because the UHB card of membership contains insured benefits. The laws states "NO HOSPITAL CAN DISCRIMINATE AGAINST ANYONE'S INSURANCE PLAN".
He was taken into ICU/ CCU (coronary care unit) and was treated.
With the UHB, he has a $20,000.00 Critical Care Benefit for ICU/CCU that pay's $1,000.00 a day, with no deductible. (This benefit can be used multiple times a year for each family member).
His bill was reduced to $14,720.00 due to the "pre-negotiated contracted rate". PPO savings.
He was in CCU for 5 days. That equates to $5,000.00 of coverage. (Remember, CCU/ICU pays $1,000.00/ a day, per family member, multiple times per year, no deductible.
He received the $500.00 indemnity per day for each day in the hospital for 5 days. (This was on top of what his UHB card already did for him.)
Plus he saves more on maintenance medication from the pharmacy, up to 86%.
| | Cost & Benefit Details | $46,000.00 Initial cost
-$31,280.00 Reduced, (pre-negotiated contracted rate PPO).
$14,720.00 Balance left to pay, however;
-$5,000.00 $1,000.00/day X 5 days in CCU
$9,720.00 Balance left to pay however;
-$2500.00 $500.00/day X 5 days in the hospital
$7,220.00 Balance left to pay, however;
(We are not including how much he saved on maintenance medication)
Total patient responsibility after a $46,000.00 heart attack was $7,220.00. This client had the Platinum Plan that cost him $184.95 per month or $2,219.40 for the year. If you compare that to a traditional major medical plan he would have been paying around $5,592.00 per year. That is $3,373.00 more a year than his UHB plan. If he had a major medical he would have been out of pocket for this hospital stay around $6,000.00 compared to the $7,220.00 but would have paid $3,373.00 more per year for it. What he saved in 1 year of payments more than paid for the difference of his out of pocket expense.
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