Preferred Provider Organizations - Legislation & jurisprudence
Research News and Information

Monday, November 23, 2009

The price is now right. UnitedHealth Group's settlement on benchmarking databases could make out-of-network care costs more transparent, equal, some say.

17 Jan 2009 Disagreement surrounds the discussion of whether the demise of two Ingenix price databases will aid the provider-payer relationship. Karen Ignagni, AHIP's CEO, questions the objective, wondering why in some cases "billings so exceed reimbursement." ... Read more...

Silent PPOs: the stealth discounting of provider reimbursement.

30 Aug 2005 Physicians are losing millions of dollars per year from payers engaging in abusive discounting practices. One of the worst of these practices is the silent PPO. This article explains what a silent PPO is and how it unlawfully reduces a provider's ... Read more...

Finance issue brief: any willing provider: year end report-2003.

29 Dec 2003 Today, almost half the states have laws obligating managed care organizations (MCOs) such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) to contract with any willing health care provider. Although most ... Read more...

Latest indexed articles for 'Preferred Provider Organizations - Legislation & jurisprudence'

These are the very latest articles for this heading:

• The price is now right. UnitedHealth Group's settlement on benchmarking databases could make out-of-network care costs more transparent, equal, some say. 17 Jan 2009
• The why and how about risk contracts. 30 Oct 2008
• Out-of-network payments for ESRD care: the National Renal Alliance case. 29 Jun 2008
• What's behind the veil? 29 Apr 2008
• Calif. wants another slice of UnitedHealth pie. PacifiCare violations could cost insurer up to $1.3 billion. 2 Feb 2008
• Round three. 30 Jan 2008
• A "clear" win. 30 Jul 2007
• Keeping a tight rein. 30 Mar 2007
• Spoiling for a rematch. 27 Feb 2007
• Do payers really want transparency in health care? 30 Dec 2006
• Rental PPO networks--be aware! A discount here may show up again and again. 30 Aug 2006
• Derbyshire primary care trust "failed to consult" over contract. 25 May 2006
• Aurora Health Care, Inc. and Wisconsin Physician Service Insurance Corporation engaged in lawsuit. 29 Apr 2006
• Family feud. 29 Nov 2005
• Silent PPOs: the stealth discounting of provider reimbursement. 30 Aug 2005
• Antitrust revisited: the pitfalls of the messenger model. 27 Feb 2005
• More no-fault auto insurer issues. 30 Jul 2004
• Down the beaten HIPAA path. 30 Jan 2004
• Play fair. Ark. AG accuses Blues of monopolizing local market. 17 Jan 2004
• Finance issue brief: any willing provider: year end report-2003. 29 Dec 2003

See a longer list of these articles.

Technical information about 'Preferred Provider Organizations'

Definition: Arrangements negotiated between a third-party payer (often a self-insured company or union trust fund) and a group of health-care providers (hospitals and physicians) who furnish services at lower than usual fees, and, in return, receive prompt payment and an expectation of an increased volume of patients.

Descriptor UI: D011243

Alternative terms: Preferred Provider Organizations; Preferred Provider Organization; Organizations, Preferred Provider; Organization, Preferred Provider;

Allowable Qualifiers: classification; economics; history; legislation & jurisprudence; manpower; organization & administration; standards; trends; utilization; statistics & numerical data; ethics;

Tree Number: N03.219.521.576.343.800.750; N04.590.374.410.750;

Online Note: use INSURANCE, HEALTH to search PREFERRED PROVIDER ORGANIZATIONS 1984

History Note: 91(85); was see under MANAGED CARE PROGRAMS 1990; was see under INSURANCE, HEALTH 1985-89; was see INSURANCE, HEALTH 1984

Technical Notes: specify geog if possible; DF: PPO