Silent Discounting PPO Arrangements

1
Silent Discounting (PPO) Arrangements

• Ecom PPO.com, Inc.

2
What is a Silent PPO?

• The most literal interpretation is  Any
  organization that acts like or calls themselves a
  PPO, yet takes discounts on medical claims
  without the knowledge or contractual consent of a
  medical provider. 
• The more realistic interpretation and most common
  answer is Any organization that takes discounts
  on medical claims without a legitimate
  relationship (provider contract or leasing
  agreement) that allows for access to discounts.

3
Why do Silent PPOs exist?

• Silent discounting arrangements exist as a result
  of fallacies in the current system. 
• Belief that if consumers are penalized enough
  they will only seek a provider in the PPO chosen
  by the consumers health plan.
• Belief that selection of PPOs based on geography
  will provide satisfactory access to providers.
• Ignoring the importance of freedom of choice by
  consumers when seeking medical treatment.

4
Who are these Silent Networks the answer might
surprise you!

• Silent discounts are provided to payers by a
  number of different companies who call themselves
  a variety of vendor types. These companies use
  Silent discount arrangements as the basis for
  their entire business model.
• However, the organizations that provide the
  majority of Silent discounts to payers of all
  types are themselves, in fact, some of the
  largest legitimate and best known PPOs.

5
Who is to blame for the problem?

• It is easy for everyone to point fingers at the
  organizations that provide these Silent
  discounts to the payers as the chief culprits. 
  However, if the payers did not agree to pay a
  large percentage of the savings to the
  organizations providing the discounts, they would
  simply cease to exist.
• Taken a step further, if the payers were
  precluded from acquiring and utilizing these
  discounts legally and the laws were ENFORCED,
  then the Silent organizations would cease to
  exist almost immediately.

6
Who pays the price for all of this activity?

• Medical providers lose billions of dollars each
  year to discounts that were taken on their claims
  without knowledge and or consent.
• With most every provider willing to join most any
  PPO network today, the providers are doing their
  part, but the practice of Silent discounts is a
  multi-billion dollar business in our industry.

7
What is the answer?

• Better initial selection of PPOs by health plans
  and carriers has been proven as a way to
  eliminate the majority of out-of-network claims,
  which in turn will help eliminate the need for
  Silent discount arrangements.
• There are now laws in 14 states that were
  designed, in part, to eliminate the use of
  Silent discount arrangements and yet they are
  not being enforced.  The group with the deep
  pockets is not the vendors providing the
  discounts, but rather the carriers and health
  plans that continue to use these vendors.  Until
  some pressure is brought against these
  organizations the problems will continue and the
  providers will continue to pay the price.