PPO

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...

Sedgwick: CA Doctors Still Waiting for Purloined PPO Reimbursement

In January, Sedgwick Claims Management Services, Inc. admitted to shortchanging a California orthopedic practice by hundreds of thousands of dollars—thanks to bogus Preferred...

City of Riverside Pays MD $31 by Triple-Stacking PPOs

This week’s Diabolical Discounter is the City of Riverside. This self-insured public employer slashed a doctor’s reimbursement for a municipal worker’s Evaluation and Managem...

Diabolical Discounts: CA Employers Are Getting Ripped Off

In California, doctors who treat injured workers are seeing their revenue collapse due to exploitative discount reimbursement schemes. California Senate Bill 863, whic...