PPOs
PPO vs Network: Who's Taking Your Money?
Nov 10, 2021
PPO vs Network: Who's Taking Your Money?
We’ve told the story many times: a doctor signs a discount contract, hoping to bring in more patients. Almost immediately, revenue for treating injured workers is down across...
Med-Legal: PPO Discounts Do NOT Apply to MLFS
Aug 17, 2021
Med-Legal: PPO Discounts Do NOT Apply to MLFS
Preferred Provider Organization (PPO) and other network discounts do not apply to the Medical-Legal Fee Schedule (MLFS). Period.In other words, the MLFS and OMFS are c...
Anthem:  PPO Discounts Result in Payments BELOW Medicare
May 19, 2021
Anthem: PPO Discounts Result in Payments BELOW Medicare
Q:  How much can a workers’ comp provider lose by signing a Preferred Provider Organization (PPO) agreement?A:  Much, much more than the provider probably realizes.
Athens Must Stop Taking Unnamed PPO Discounts
May 5, 2021
Athens Must Stop Taking Unnamed PPO Discounts
As advocates for a fair and just workers’ comp system, we here at DaisyBill feel compelled to remind insurer Athens Administrators of an important fact about California worke...
CCSF Stands Up On Behalf of Providers
May 4, 2021
CCSF Stands Up On Behalf of Providers
Many payers delegate bill review to an outside entity, trusting the bill review vendor to properly reimburse providers. But when a provider disputes a denial or adjustment, i...
Prime Health: Unsigned Contract Tale Continues
May 3, 2021
Prime Health: Unsigned Contract Tale Continues
Almost immediately after DaisyBill called out Prime Health Services (PHS) for questionable PPO practices, it was clear we struck a nerve. PHS attorneys sent DaisyBill a ‘plea...
California MPNs: Camouflage for Discounts and Denials
Apr 27, 2021
California MPNs: Camouflage for Discounts and Denials
Medical Provider Networks (MPNs) are under fire — as they should be.Far too often, Calforina claims administrators (aka ‘payers’) use MPNs — and providers’ unfamiliari...
Provider Warning: Prime Health Services (Part II)
Apr 20, 2021
Provider Warning: Prime Health Services (Part II)
Prime Health Services (PHS) provided an unbelievable example of just how far PHS will go to secure unearned PPO discounts for their “clients”, including producing a missing s...
Provider Warning: Prime Health Services (Part I)
Apr 19, 2021
Provider Warning: Prime Health Services (Part I)
Recently, a provider made the unfortunate mistake of signing a Prime Health Services (PHS) Preferred Provider Agreement contract, commonly known as a PPO agreement. While not...
ESIS + Conduent + StrataCare  = Provider Torment
Mar 2, 2021
ESIS + Conduent + StrataCare = Provider Torment
Preferred Provider Organizations (PPOs) profit from reducing the reimbursements providers receive for treating injured workers. Yet, we would argue that providers (and injure...
CorVel Disguises PPO Discounts
Mar 4, 2020
CorVel Disguises PPO Discounts
We’ve raised the alarm about Preferred Provider Organization (PPO) and Network discount contracts before. Supposedly, in exchange for more patients, these PPO and Network con...