Fee schedule changes effective Jan. 1, 2011

Priority Health's mission is to be the nation’s leader in innovative health solutions – making health care obtainable for all. We're committed to providing affordable and excellent health care to individuals and employers through an ever–expanding array of products and services. To accomplish this, we conduct a review of the fee schedules annually.

We keep health care affordable
The rise in health care costs is a well-documented problem. Priority Health continually evaluates national and regional data to develop fee schedules that balance the needs of providers with those of employers and members who bear the burden of these costs. Fee schedules are only one of the many tools we use to keep health care affordable. Other tools include, but are not limited to, proper utilization, improved technology, better procedures, pharmaceutical reviews and cost sharing by which members assume more of the costs for services they access.

Payments to health care providers remain equitable
Our adjustments to fee schedules typically result in raising some fees while lowering others. We must always confirm there is a proper balance between primary care and specialty care as well as among specialists themselves. Our goal is to reimburse all providers at a fair market value.

Customers have a choice when accessing care
Employers and members deserve a choice when accessing care. Fee schedule changes are one way we strive to remain competitive in the market, allowing us to remain a viable choice to our customers. Priority Health is a nonprofit corporation, and we’re proud that 90 cents of every premium dollar is spent on reimbursing providers for delivery of care to our members.

We're committed to working with you in partnership within our communities to achieve national best-practice levels of health care costs per capita and to improve the patient’s experience of care and clinical outcomes. At Priority Health we’re working to achieve this "Triple Aim" through such means as enhancing performance on the PIP measures and rewarding improvement.

You may obtain a copy of the new fee schedule from your PO or PHO administrative staff, or request one from your PAC.

Topics: