Blog Reader Question-Do PPO's Save Money
Do Workers Comp Preferred Provider Organizations (PPO's) really save money? Do PPO's diminish the level of care that our injured employees would receive vs. having no PPO?
Workers Comp PPO's have gone from a simple discount for certain providers to very complex systems. PPO's vary among each type of service offered. They can be a generalist PPO where all the providers are one large PPO, to specialist PPO's such as Pharmaceutical or Physical Therapy.
The PPO's pre-negotiate a discount from the medical providers. The providers sign on with PPO's to drive more business to their practices.
Do PPO's diminish any type of care? No, as in all the years I have been in Workers Comp, I have never seen an instance of where an injured employee in a PPO did not receive the same level of treatment that a non-PPO employee received to treat their injuries.
PPO's do save money if they are examined as to what they really are - a group of medical providers that were willing to take a discount. Quite often, the PPO's sign up as many medical providers as possible whether they are industrial-type providers or not. As the PPO makes their $ off the employee seeing one of their medical providers, the marketing department for PPO's will attempt to sign up all the medical providers in a certain area.
Our recommendation is to send the employees to the medical providers that you have an established working relationship with. Sometimes, saving 15% on a medical bill may not be worth it if, for example, the doctor did not know that you have a full Return to Work program in place and wrote an employee out of work with a 25lb weight lifting restriction.
California has proven that medical networks do work for the most part. CA's Medical Provider Networks (MPN's) have saved the employers in CA millions of $ over the last five years. In my opinion, this was the rule that turned the tide for California Workers Comp.
There are also EPO's such as Employers Choice Network out of Charlotte, NC. They are able to custom-build medical networks, even within the network that you already have in place. They provide the best of both worlds - a discount and industrial minded medical provider.
Workers Comp PPO's have gone from a simple discount for certain providers to very complex systems. PPO's vary among each type of service offered. They can be a generalist PPO where all the providers are one large PPO, to specialist PPO's such as Pharmaceutical or Physical Therapy.
The PPO's pre-negotiate a discount from the medical providers. The providers sign on with PPO's to drive more business to their practices.
Do PPO's diminish any type of care? No, as in all the years I have been in Workers Comp, I have never seen an instance of where an injured employee in a PPO did not receive the same level of treatment that a non-PPO employee received to treat their injuries.
PPO's do save money if they are examined as to what they really are - a group of medical providers that were willing to take a discount. Quite often, the PPO's sign up as many medical providers as possible whether they are industrial-type providers or not. As the PPO makes their $ off the employee seeing one of their medical providers, the marketing department for PPO's will attempt to sign up all the medical providers in a certain area.
Our recommendation is to send the employees to the medical providers that you have an established working relationship with. Sometimes, saving 15% on a medical bill may not be worth it if, for example, the doctor did not know that you have a full Return to Work program in place and wrote an employee out of work with a 25lb weight lifting restriction.
California has proven that medical networks do work for the most part. CA's Medical Provider Networks (MPN's) have saved the employers in CA millions of $ over the last five years. In my opinion, this was the rule that turned the tide for California Workers Comp.
There are also EPO's such as Employers Choice Network out of Charlotte, NC. They are able to custom-build medical networks, even within the network that you already have in place. They provide the best of both worlds - a discount and industrial minded medical provider.
Labels: Workers Comp PPO's
posted by James J Moore at 8:29 PM
