PPO

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...

Taxpayers Beware: Anaheim Misreports Payment Data

Citizens of Anaheim, CA, may want to examine the city’s books closely, given the suspicious accounting of taxpayer dollars designated for the care...

CA Employers: Comp Premium Hike Based On Bad Data

While most states are lowering employers’ workers’ comp premiums, California is heading in the opposite direction. Insurance Commissioner Ricardo Lara approved a premium rate...

CA: Business Insider Falls for Insurer Propaganda

Business Insider published a cringy slop of insurer talking points, uncritically parroting insurers’ preferred narrative about the coming increase...

Diabolical Discounts: Rampant Anthem PPO Carnage

Preferred Provider Organization (PPO) Anthem Blue Cross is enabling egregious abuse of California providers at scale. Since June, dozens of claims administrators have ...

Diabolical Discounts: Berkshire Hathaway's Reimbursement Roulette (Part 1)

A sad fact about California workers’ comp: once a doctor joins a Preferred Provider Organization (PPO), there’s no predicting how devastating the impact on practice revenue w...