The Wrongful Discount Letters are specific appeal templates to use when a payer has wrongfully applied a discount to your services.
More details about this too common phenomenon are found in my blog post “How Do Chiropractors Protect Themselves From Wrongful Discounts?”
Specifically, the first template letter is in reference to “The Silent PPO.” The Silent PPO can be a third party payer that is attempting to pay an out of network provider (that’s you) for a claim for their beneficiary (your patient). Since they don’t actually have you locked in to contractually accept their discounted rate, the Silent PPO conveniently acts as if you have a contract and processes your claim according to the in-network rate. Technically, there’s nothing very silent about this, since they simply paid your claim incorrectly. And certainly, it is possible that this claim was paid in error at the lower, contracted rate. Unfortunately, the frequency at which this occurs is alarmingly common and makes one suspect of how these errors can be so routine. Additionally, since doctors often receive checks that batch groups of claims together in one lump sum, it is entirely possible that this “error” goes missed and with it, you have been paid less than you deserve and effectively, the PPO has received a “silent” discount from you.
The second scenario is a variation of the first where the PPO actually pays you correctly, but processes the claim as in-network thereby “obligating” you to accept a contractual write-off that prohibits you from balance billing your patient. Again, since there is no contract, this is incorrect and the payer is attempting to force you toward accepting a discount that you didn’t agree to, this time on behalf of your patient.
Silent PPOs can also “attach” themselves to an existing contract that you have with a carrier. The language in your contracts may allow the payer to act as a broker reselling your contract with other partners. If your contract was not well negotiated, you are now taking reduced payments from multiple carriers.
WHAT THE EBOOK CONTAINS
- Silent PPO Appeal Letter Templates for use in situations as described above
Cost: $19.97 – Wrongful Discount Letter Templates (click to Buy)
