Network Discounts

Data: Drastic PPO Discounts Revealed

It’s time to reveal what’s really harming injured workers in California. Starting today, DaisyBill will publicize the reduced reimbursement rates foisted on our provid...

Med-Legal Reports: Always Include Page Count Verification!

Preferred Provider Organization (PPO) and other network discounts do not apply to the Medical-Legal Fee Schedule (MLFS). Period.In other words, the MLFS and OMFS are c...

SB 537 Reveals Murky World of Discount Contracts

In 2019, California passed Senate Bill 537. Among the changes to take effect on July 1st is a disclosure mandate requiring discount contracting entities to disclose to the cl...

Anthem: PPO Discount Payments BELOW Medicare

Q: How much can a workers’ comp provider lose by signing a Preferred Provider Organization (PPO) agreement?A: Much, much more than the provider probably realizes.

Anthem/SCIF: MPN Kickback Scheme?

Healthcare software firm CareCloud recently agreed to a $3.8 million settlement, in part to resolve allegations that it traded unlawful payments for referrals, in violation o...

Athens Must Stop Taking Unnamed PPO Discounts

As advocates for a fair and just workers’ comp system, we here at DaisyBill feel compelled to remind insurer Athens Administrators of an important fact about California worke...

CCSF Stands Up On Behalf of Providers

Many payers delegate bill review to an outside entity, trusting the bill review vendor to properly reimburse providers. But when a provider disputes a denial or adjustment, i...

Prime Health: Unsigned Contract Tale Continues

Almost immediately after DaisyBill called out Prime Health Services (PHS) for questionable PPO practices, it was clear we struck a nerve. PHS attorneys sent DaisyBill a ‘plea...

California MPNs: Camouflage for Discounts and Denials

Medical Provider Networks (MPNs) are under fire — as they should be.Far too often, Calforina claims administrators (aka ‘payers’) use MPNs — and providers’ unfamiliari...

Payola? SCIF / Anthem Coordinate Provider MPN Shakedown

State Compensation Insurance Fund (SCIF) and Anthem Blue Cross (Anthem) have hacked the Medical Provider Network (MPN) system to apparently shake down providers. A recent ema...

Mob Rule: SCIF/Anthem Hold Patient(s) Hostage

On paper, Medical Provider Networks (MPNs) are a simple workers’ comp quality/cost-control measure. Employers designate an MPN, and injured workers choose from among the MPN ...

Provider Warning: Prime Health Services (Part II)

Prime Health Services (PHS) provided an unbelievable example of just how far PHS will go to secure unearned PPO discounts for their “clients”, including producing a missing s...