Be sure to read any faxes these days from your neighborly PPO.  BD

The AMA and several state medical societies are engaged in ongoing discussions with a PPO network that sent a fax to physicians that appeared to be a routine request for tax information -- but also bound physicians to having their reimbursement cut by 25%.

San Diego-based Three Rivers Provider Network sent the fax to physicians who had treated member patients, but who were not part of any TRPN network. TRPN not only has direct contracts with physicians, but also rents networks from other PPOs -- a practice which organized medicine has criticized as a "silent PPO" because physicians never negotiate rates with a plan, yet find themselves in it because they have signed a deal with a PPO that has rented out its network to someone else.

However, the TRPN fax also contained a paragraph stating that physicians would agree "payment of services will be 75% of provider's total billed charges for covered services." Physicians would sign one form; there was no opportunity to opt out of or negotiate the cut.

It's not uncommon for Howard H. Rosenblum, MD, an ophthalmologist in Nashville, Tenn., to receive a random fax from an insurance company asking him to fill out a W-9, so when Dr. Rosenblum received the TRPN form, he said he signed the document without much hesitation. Several months later, while conducting a spot check of his claims receipts, Dr. Rosenblum noticed he wasn't getting his normal fee from the insurance companies with which he contracts.

Source: AMNews: June 4, 2007. Physicians say PPO network's fax masked 25% pay cut ... American Medical News


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