PPO
May 28, 2025
Insurance Execs Make Bank While Comp Crumbles
Business Insurance recently named the five highest-paid executives in the country for 2024. These executives’ compensation packages are, as expected, massive—an...
May 16, 2025
Diabolical Discounts: Ralphs Pays MD $44 to Treat Injured Worker
Our weekly “Diabolical Discounts” features the most atrocious examples of the low reimbursements doctors receive for treating California’s injured workers.<...
May 13, 2025
Long Beach Pays CA Doctors Less Than Interpreters (and Plumbers)
Last week’s Diabolical Discounts revealed that the City of Long Beach paid a doctor just over $32 to treat an injured municipal employee. The article provoked outrage–and com...
May 9, 2025
Diabolical Discounts: Long Beach Pays Doctor $32 to Treat Injured Employee
Across the nation, providers struggle to treat injured workers without financially damaging their practices. The problem is especially ugly in California, where extrem...
May 2, 2025
Diabolical Discounts: Disney & MultiPlan Take 56% Off Provider's Bill
Across the nation, providers struggle to treat injured workers without financially damaging their practices. The problem is especially ugly in California, where extreme reimb...
May 1, 2025
Please Advise: An Open Letter to the CA DWC (cc: CA Attorneys)
We have a question for California’s Division of Workers’ Compensation (CA attorney comments are always welcomed, too): What should a medical practice do in the followi...
Apr 10, 2025
Sedgwick’s Shell Game: From Coventry to CareWorks, the Chicanery Continues
Sedgwick Claims Management Services, Inc., a Third-Party Administrator (TPA), appears to be throwing any available spaghetti at the wall to continue funneling e...
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Apr 2, 2025
Sedgwick Owes Practice Over $570K…Has Paid Just $12K
Readers may recall last year’s daisyNews report on how Third-Party Administrator (TPA) Sedgwick Claims Management Services, Inc. underpaid a California orthopedic provider by...
Mar 13, 2025
Paduda's Predictions: An Insult to Workers’ Comp Doctors
Joe Paduda of Managed Care Matters is (understandably) worried about Americans losing their health insurance due to Republicans' cuts to healthcare spending—but his ar...
Oct 22, 2024
Sedgwick Stiffs CA Practice for Over $300,000
In California, claims administrators can siphon staggering amounts of revenue from practices using invalid Preferred Provider Organization (PPO) discounts—and doctors have no...
Oct 10, 2024
Medicare Advantage & Workers' Comp: Why Providers Reject Both
Becker’sreports that hospitals and health systems across the nation are giving up on Medicare Advantage, terminating contracts and refusing to treat patients co...
Sep 16, 2024
No, Doctors Aren't the Culprits in CA Workers' Comp
It’s time to take a sledgehammer to one of the most pernicious myths about workers’ comp in California. For decades, the Division of Workers’ Compensation (DWC) has fed legis...