State regulators last month granted Priority Health approval to incorporate cash rewards into its fully-insured PPO policies that would pay members from $50 to $200 for using a care provider that charges a “fair market price” for a medical procedure and maintains high quality standards. The fair market price is determined by a range of charges within a market and is identified by a cost estimator linked from Priority Health’s website, according to documents the health plan filed with theMichigan Department of Insurance and Financial Services.
To earn the reward, members need to look up price data on a covered medical procedure or service and read the information, locate a fair market price facility, and then use that care provider. Members who follow the first two steps but seek care at a facility that’s not designated as offering a fair market price would receive a nominal “education” reward of $5.
Covered procedures include colonoscopies, sleep studies, MRI and CT scans, ear tubes, cataract surgeries, lithotripsy, knee and shoulder arthroscopy, total hysterectomy, and total knee and hip joint replacement.
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