If your patient has med pay for $5,000 an unscrupulous med pay insurance carrier can make a deal behind your back to deny you full payment.

Silent PPOs create agreements by auto insurers allowing them into the Silent PPO, [e.g. Blue Cross] to pay on your Med Pay only the terms of the lowest discounted rate available. Med Pay then pays the lowest discounted rate of the doctor, even though the patient did not agree that the PPO discount should apply in their PI case. This is now a nationwide problem.

When the doctor negotiated the discount with Blue Shield, the doctor intended, in good faith, to give a fee discount only in exchange for referrals from Blue Cross members. Silent PPOs do not make referrals.

The med pay carrier instead of paying reasonable Personal Injury Fees pays only the amount the doctor agreed to get from Blue Shield. Worse still, many of the Silent PPO’s do not allow for balance billing from an honest PI attorney.

This is a national problem as discussed by the National Assn of Chiropractic Attorneys [NACA]. In fact, two states have laws discouraging this scheme. Minnesota has a Network Shared Contract Law which helps doctor from getting sand-bagged by Silent PPO’s.

Florida, where over 85% of chiropractors belong the to the Florida Chiropractic Assn [take note California!] prohibits a Blue Shield from “selling” its PPO list unless it gives notice to the doctors in advance.

California does not have any protection from the Silent PPO’s. This problem is increasing. Solution would be to get legislation passed to follow the Minnesota or Florida protective laws.

In the meanwhile, carefully choose which PPO to work with. If they are making secret deals with Mercury etc, then make a business decision to see if the PPO is a good partner or not. Drop your PPO if they take away your PI benefits.

Matt Fisher is a comedian, but his sister’s story is tragic. Progressive heavily advertises a “concierge level” of claims service—Fisher wrote in a blog that went viral.

Katie Fisher was killed in 2010, with very clear fault. The defendant ran a red light. The defendant had little insurance. The Fisher family was forced to seek Underinsured insurance coverage from its own company. Progressive insured Katie Fisher.

Fisher’s parents were put in a spot where they had to sue the defendant to get their own insurance to pay. The defendant admitted fault. Suit was not necessary. But Progressive refused to settle with the family. Litigation started. The Fisher’s sued their own insurance company. What made this blog famous was Matt Fisher observing that “if you are insured by Progressive, and they owe you money, they will defend your killer in court in order to not pay you your policy.”

Ouch!

Forcing the Fisher’s to try the case against the defendant was completely unnecessary.