PPO

CA Billing Alert: Alisal Union Schools’ TPA Pays Below Medicare Rates

California’s fee schedule for workers’ comp treatment pays physicians more than Medicare rates (currently 55% more) to account for the extraordinary time, work, and administr...

Data: PPOs Are Another “Cost Control” Measure That Hurts CA Employers

California employers pay more than almost any other state for comp coverage, with premiums set to rise again in September. California claims take twice as long and cost twice...

The Hartford’s Authorization Exposes “Pay to Treat” System

California employers pay insurers like The Hartford to ensure that when one of their employees sustains a work injury, the providers who treat them get paid. Instead, ...

Tennessee Just Showed the Way For California to Fight PPOs

California employers are getting fleeced twice over.First, the Workers' Compensation Insurance Rating Bureau (WCIRB) recommended a 10.4% premium hike on top of last ye...

Zurich's MPN Violates CA Law (Again) - Tesla Should Be Asking Questions

To ensure injured workers' access to care, California has laws governing Medical Provider Networks (MPNs). Zurich Insurance North America continues to treat those laws as opt...

CA's Fee Schedule Increase Was a Raise for PPOs, Not So Much for Physicians

The California Division of Workers’ Compensation (CA DWC) raised Physician Fee Schedule rates effective March 1, 2026. The agency increased the Conversion Factor used to calc...

CA Pays 155% Medicare. Physicians Get 128%. Where's the Rest?

California's Official Medical Fee Schedule comprises multiple fee schedules governing reimbursement for different categories of workers' comp medical care. Below, we break do...

CA: The Corruption Under Newsom’s Nose

California Governor Gavin Newsom has never been charged with (or even credibly accused of) any serious crime. However, the presidential hopeful may have a serious blind spot ...

Former PPO Employee: "I Felt Like I Was 'Legally' Robbing" Doctors

Prime Health Services (PHS) operates like a high-pressure "call center," pushing employees to sign providers onto reimbursement discount contracts by making promises t...

Sedgwick (Still!) Owes CA Practice $500k+ After Bogus PPO Discounts

Sedgwick Claims Management Services,Inc. has withheld hundreds of thousands of dollars in reimbursement from a single California orthopedic practi...

CA: How to Challenge PPO Discounts

California providers, if you suspect a reimbursement discount is invalid, you have the right to demand proof of an applicable discount contract.As we detailed last wee...

daisyData: CA Providers Paid at Fractions of Fee Schedule Rates

As daisyNews recently demonstrated with current, verifiable data:California’s workers’ comp fee schedule is one of the lowest nationwide, andData from ov...