Protecting Yourself from Silent PPOs

Have you ever opened the mail and in the midst of all your payments you suddenly realize you seem to be participating with insurance companies you never heard of or don’t have contracts for? When reading the fine print you realize what network paid you. This is what is referred to as a silent PPO and only careful review of your existing contracts can identify how this happened.

Silent PPOs attach themselves to an existing contract that you have with a carrier. The language in your contracts allow carriers to act as a broker reselling your terms with others. If your contract was not well negotiated you are now taking reduced payments from multiple carriers.

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You can protect your practice by asking for specific language added to your contract stating that you get final selection of who you contract with and that you must be notified in writing every time a new carrier is added. You should also include the ability to opt out of any plan you choose not to participate with.

By asking for this option you protect yourself proactively instead of always having to react. This also allows for you to make a listing of healthplans you are actually participating with and arms your staff with the knowledge of who you are contracted with so that they know the correct amounts to collect at the time of service.

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