PPO Networks
Barbara Boutin CO, CO(c)
Description
Collection
Title:
PPO Networks
Creator:
Barbara Boutin CO, CO(c)
Date:
8/26/2009
Text:
Good Day List,
I am wondering if any other small O and P companies out there are
experiencing what we are experience right now.
Years ago (7 ½) we were new in practice and were lured in by PPO networks
telling us that we would have excellent exposure to many more clients if we
signed up with them.
At that time we did not really understand the Insurance Industry like we do
now.
For example, we are contracted with a very obscure little plan, XYZ PPO
Network.
How they work is, they hook up with THE large Insurance Companies when
patients are utilizing their out of network benefits.
Through the PPO networks, the large insurance companies will take a large
discount off the top – because of the contract with the PPO network.
They are allowed to hook into the PPO net work as “contracted rates” but
then can continue to provide us with “out of network reimbursements” which
we all know are never as good as in network.
In addition, it is stated on the EOB, patient is not responsible for
negotiated discount.
There is no indication on the insurance card that the member is a part of
this network.
I am just wondering how many out there are experiencing the very heavy
discounts that we are for accepting patients utilizing out of network
benefits with the larger insurance companies, and then being blind sided by
discounts that were not obvious up front?
Barbara Boutin
CO, C.O. (c), BSc
email-logo
51 E. Monterey Way
Phoenix, Arizona 85012
602-263-1010
Fax 602-263-7473
This email, including attachments, is covered by the Electronic
Communications Privacy Act, 18 USC 2510-2521, and the HIPAA privacy
regulations and, as such, is confidential and may be legally privileged. It
is intended for the use of the individual or entity to which it is addressed
and may contain certain information that is privileged, confidential, and
exempt from disclosure under applicable law. If the reader of this email is
not the intended recipient or agent responsible for delivering or copying
this communication and attachments, you are hereby notified that any
retention, dissemination, distribution, or copying of this communication and
any attachments is strictly prohibited. If you have received this
communication in error, please reply to the sender that you received it in
error, then delete it. Thank you for your cooperation.
I am wondering if any other small O and P companies out there are
experiencing what we are experience right now.
Years ago (7 ½) we were new in practice and were lured in by PPO networks
telling us that we would have excellent exposure to many more clients if we
signed up with them.
At that time we did not really understand the Insurance Industry like we do
now.
For example, we are contracted with a very obscure little plan, XYZ PPO
Network.
How they work is, they hook up with THE large Insurance Companies when
patients are utilizing their out of network benefits.
Through the PPO networks, the large insurance companies will take a large
discount off the top – because of the contract with the PPO network.
They are allowed to hook into the PPO net work as “contracted rates” but
then can continue to provide us with “out of network reimbursements” which
we all know are never as good as in network.
In addition, it is stated on the EOB, patient is not responsible for
negotiated discount.
There is no indication on the insurance card that the member is a part of
this network.
I am just wondering how many out there are experiencing the very heavy
discounts that we are for accepting patients utilizing out of network
benefits with the larger insurance companies, and then being blind sided by
discounts that were not obvious up front?
Barbara Boutin
CO, C.O. (c), BSc
email-logo
51 E. Monterey Way
Phoenix, Arizona 85012
602-263-1010
Fax 602-263-7473
This email, including attachments, is covered by the Electronic
Communications Privacy Act, 18 USC 2510-2521, and the HIPAA privacy
regulations and, as such, is confidential and may be legally privileged. It
is intended for the use of the individual or entity to which it is addressed
and may contain certain information that is privileged, confidential, and
exempt from disclosure under applicable law. If the reader of this email is
not the intended recipient or agent responsible for delivering or copying
this communication and attachments, you are hereby notified that any
retention, dissemination, distribution, or copying of this communication and
any attachments is strictly prohibited. If you have received this
communication in error, please reply to the sender that you received it in
error, then delete it. Thank you for your cooperation.
Citation
Barbara Boutin CO, CO(c), “PPO Networks,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/230661.
