PPO
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...
Aug 13, 2024
Apricus Applies Massive, Invalid PPO Discount for Sedgwick
Specialty network vendor Apricus, acting on behalf of Third-Party Administrator (TPA) Sedgwick, recently applied an invalid Preferred Provider Organization (PPO) discount to ...
Aug 1, 2024
Gallagher Bassett Shows MPNs Are a Painful Waste
A recent exchange between a provider and Gallagher Bassett offers a perfect example of why California’s Medical Provider Network (MPN) system is a pointless, convoluted, unna...
Jun 19, 2024
CA MPNs Harm Employers, Injured Workers & Providers
California’s Medical Provider Network (MPN) system is an unmitigated failure, causing genuine harm to injured workers, health care providers, and employers. The Divisi...
Sep 26, 2023
ProPublica/NPR: Fees & Discounts Gutting Provider Revenue
ProPublica and NPR recently published an exposé on entities that impose fees on doctors who accept electronic funds transfer (EFT) payments. These fees c...