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Auto Insurance Companies and Worker’s Compensation Insurance Companies Continue to Be Sued Over Silent PPO Discounts on Medical Claims

Since our firm filed the first Silent PPO class actions some years ago, there have been a number of other similar individual and class action cases in various states against automobile insurers and worker's compensation insurers. Discounts on these two types of insurance are the more easily identifiable Silent PPO discounting schemes because they typically involve a set of state auto or worker's compensation insurance laws and fairly standard insurance policy language.

Traditional indemnity insurance benefits, like auto PIP and Med Pay benefits, usually pay at a higher rate than health insurance plans. The auto and worker's compensation insurers have been reducing benefits based on their own, undisclosed UCR schedules for years but Silent PPO discounts allow them to reduce benefits beyond the average 20% reduction we see when UCR rates are applied to medical bills. The financial incentive of the big reductions characteristic of a Silent PPO means that you will continue to see Silent PPO discounts on your auto and worker's compensation EOBs and EORs.

Providers who regularly treat accident victims or people hurt at work, like orthopedic doctors, trauma facilities and MRI facilities, have to watch their EOBs and EORs carefully. These facilities could be losing thousands of dollars per medical claim. The aggregate amount of such reductions could be substantial. Our book the Ultimate Providers Guide to Silent PPOs discusses Silent PPO discounting, how to protect your practice and how to get back the money you lost to Silent PPOs.

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