I recently got my first full time job working for a health insurance company, working in IT, and one of the apps my team maintains handles MAC (maximum allowable cost) pricing for the company. It’s been a few months now, and I still have no idea what MAC is and why all these different values need to be manipulated. I’ve tried asking other members of my team, but they don’t know either. They only know the technical details of the app, rather than what the app’s purpose is.
When I googled it I got some answers: apparently MAC is the upper limit an insurance plan will pay for certain drugs. But for me that just adds more questions… insurance companies are allowed to tell pharmacies they won’t pay above a certain amount for drugs? Like, the pharmacy says, “This bottle costs $40” and the insurance company says, “Naw dog we’re gonna pay $35” and the pharmacy is just okay with that? Why are we allowed to do that?
If there’s anyone here who works in the health insurance industry, I could use some answers.
submitted by /u/Doctor_119
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I recently got my first full time job working for a health insurance company, working in IT, and one of the apps my team maintains handles MAC (maximum allowable cost) pricing for the company. It’s been a few months now, and I still have no idea what MAC is and why all these different values need to be manipulated. I’ve tried asking other members of my team, but they don’t know either. They only know the technical details of the app, rather than what the app’s purpose is. When I googled it I got some answers: apparently MAC is the upper limit an insurance plan will pay for certain drugs. But for me that just adds more questions… insurance companies are allowed to tell pharmacies they won’t pay above a certain amount for drugs? Like, the pharmacy says, “This bottle costs $40” and the insurance company says, “Naw dog we’re gonna pay $35” and the pharmacy is just okay with that? Why are we allowed to do that? If there’s anyone here who works in the health insurance industry, I could use some answers.
submitted by /u/Doctor_119 [link] [comments]Read Morer/HealthInsurance