Impact of Silent PPOs/Rental Networks in Workers Compensation |
Survey developed in conjunction with the Florida Orthopaedic Society
| 50% |
When a physician contracts to join a health plan network, he or she agrees to accept a discounted rate in return for the plan directing patients into his or her practice through a listing in the health plan's directory.
However, there is a deceptive market practice called a "silent PPO" or "rental network." A silent PPO/rental networks create agreements with insuring entities, allowing buyers into the Silent PPO to access the terms of the lowest discounted rate available. Patients (and other insuring entities who are members of the Silent PPO) may then access the lowest discounted rate of the healthcare provider, even though the patient is not directly a member of the plan contracted to the healthcare provider. Essentially, the network "shops" around to find the lowest rates a physician has agreed to with any insurer, then "rents" that discounted rate to another entity without the physician's knowledge or permission.
This has resulted in physicians experiencing inappropriate rate reductions without their knowledge and frustration felt throughout the workers compensation system.
Please participate in this survey so that AAOS can work with States to:
1) Develop model legislation that will seek to regulate how a physician's contract rate is sold, leased, or shared among health plans
However, there is a deceptive market practice called a "silent PPO" or "rental network." A silent PPO/rental networks create agreements with insuring entities, allowing buyers into the Silent PPO to access the terms of the lowest discounted rate available. Patients (and other insuring entities who are members of the Silent PPO) may then access the lowest discounted rate of the healthcare provider, even though the patient is not directly a member of the plan contracted to the healthcare provider. Essentially, the network "shops" around to find the lowest rates a physician has agreed to with any insurer, then "rents" that discounted rate to another entity without the physician's knowledge or permission.
This has resulted in physicians experiencing inappropriate rate reductions without their knowledge and frustration felt throughout the workers compensation system.
Please participate in this survey so that AAOS can work with States to:
1) Develop model legislation that will seek to regulate how a physician's contract rate is sold, leased, or shared among health plans
2) Ensure the physician's right of action against anyone who improperly accesses their price discount
3) Provide guidance on how to speak with State Departments of Insurance to enforce current state insurance laws to alleviate this deceptive trade practice.
3) Provide guidance on how to speak with State Departments of Insurance to enforce current state insurance laws to alleviate this deceptive trade practice.
This survey is geared towards individual physicians so please answer based on your own patient experience.