Beware: Pirates Are Attempting to Steal Your Insurance Checks!
October 11, 2010, 4:16 PM
By Tom Necela
If you have recently opened the mail only to realize that you seem to be a “participating provider” with insurance companies that you never heard of, you are certainly not alone. While it may seem silly to complain about being paid, the fact is that you are paid a contracted rate (which is sure to be less than your billed amount) for a contract that never existed. In other words, the payer has given you a “Wrongful Discount” because you never agreed to a discount in the first place!
This phenomenon – known as a “Silent PPO” – is just one of the latest in third party payer’s bag of pirate tricks aimed at reducing your payments. Unfortunately, it is becoming an increasingly common occurrence in the field of medical billing. (Yes, that means that it’s not just the chiropractors that are being picked on!)
This generally occurs in one of several ways:
The Silent PPO can be a third party payer that is attempting to pay an out of network provider (that’s you) for a claim for their beneficiary (your patient)
The second scenario is a variation of the first where the PPO actually pays you correctly, but processes the claim as in-network thereby “obligating” you to accept a contractual write-off that prohibits you from balance billing your patient.
Silent PPOs can also “attach” themselves to an existing contract that you have with a carrier.
Click here to read the full report and learn how to stop this pesky PPO pilfering.
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