Silent PPOs and Steps to Avoid Them

Silent PPOs are a growing problem, siphoning billions each year from the health care system while going completely unregulated in many states. 

In a silent PPO arrangement, an insurer sells or rents its network to a discounter that takes advantage of discounts the insurer negotiated with the physician—often unbeknownst to the physician.  

The discounter finds and gives their clients the lowest discounted rate while profiting off the margins. They claim to keep health care costs down but savings line their pockets instead of being passed along to patients or employers. Physicians lose money in these arrangements and are faced with additional administrative costs.  

Fee schedules are often sold or rented without the physician’s authorization. Discounts are applied at a lower rate than the contracted rate. Discounts are even given after the physician has cancelled the contract.

Get more information about how this happens and what you can do to stop it. Member login is required.

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Comments: 2


This has been a growing problem for many years. It has gotten to the point that you really don't know who you are contracted with until the claim is submitted and paid...or not, always at a lower rate than you thought you negotiated. Thanks for the info. It is helpful.

jldcmm at 6/24/2010 2:11:47 PM


We had this same problem. It has taken us approximately 3 years to close down all the links we were unaware of especially through Multiplan. Whenever you question your relationship to the some organization taking a discount request a copy of the contract you signed which makes you part of their network. Once you disengage from a network get it in writing and expect to produce that letter repeatedly as the network is not anxious to let the plans using them. Also read the language of any contract you sign and make sure to delete out the ability of one company making you part of another's network.

Sue at 11/30/2009 4:43:05 PM

Last Updated: 11/19/2009
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