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May 20, 2011 | Comments Off on MEDICAL LOSS RATIO
Posted by Frank Ciesla

At the presentation given by Frank Ciesla, Sharlene Hunt and Beth Christian at the New Jersey Medical Society’s Annual Meeting on Friday, May 13, 2011, in New Brunswick, we discussed the potential impact on fees paid by third party payors to providers in light of the medical loss ratio limitations set forth in the Patient Protection and Affordable Care Act (PPACA).  As part of the discussion, there was some feeling that as a result of the 85/15 or 80/20 medical loss ratio rules, third party payors would be willing to pay providers more for the services that they rendered.  I am attaching an article which indicates that States are requesting waivers from the medical loss ratio limits.  In a previous blog, we have discussed companies and unions that have requested and received waivers from the medical loss ratio.  As set forth in the article, it would appear that the future applicability of the medical loss ratio across the board is not a sure thing.


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