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Another warning about 'silent PPOs': Be careful what you sign
Their tactics are tricky, disguised, suspicious — and silent. But insurers who
want you to ignore the fine print, sign on the line and give huge discounts are misleading physicians in Indiana. The AMA and other state medical societies
have issued warnings.
The AMA Private Sector Advocacy unit has fielded numerous complaints from around the country about solicitations from Three Rivers Provider Network. The company issues what appears to be a routine request for a W-9, but the document is, in fact, an agreement to be “in network” with the company. That means giving a 25 percent discount off your fees to all the undisclosed payers in their network — if you sign.
At least one Indiana practice has been a target of Three Rivers’ tricky ploy. After submitting the W-9, that practice discovered it had to give a 25 percent discount never directly negotiated to the approximately 300 payers in the Three Rivers Network.
Since that time, Three Rivers’ officials advised the ISMA they have revised their practices, but acknowledged some of their payers and employer groups are continuing to solicit providers by using the W-9.
This month, the AMA delivered a lengthy letter to Three Rivers’ chief operating officer detailing physicians’ concerns and urging the insurer to make its contracting practices transparent.
The AMA and the ISMA urge your vigilance regarding Three Rivers and other ‘silent PPOs’. Before signing any agreement with a preferred provider plan, make sure you know what you are agreeing to and insist that the PPO disclose to you all entities having access to any discount.
Talk to your state lawmakers to produce change
The ISMA has been fighting for transparency in contracting at the Statehouse. Last year, a resolution from William Penland, M.D., and the Indiana Academy of Ophthalmology to the 2006 House of Delegates urged support of legislation on rental (silent) preferred provider networks.
A bill on this issue, HB1159—Preferred Provider Contracts, introduced in the 2007 General Assembly by Rep. Craig Fry, D-Mishawaka, died on the House calendar after failing to be called for a vote. However, legislators remain interested in pursuing change in preferred provider contracting.
Please contact your state legislators now to urge support for a measure next year. Tell them physicians should have the right to affirmatively opt-in or opt-out of any leasing or rental agreements that offer a discount to other new entities.
Identify and e-mail your legislator>>
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