Workers' Compensation Carriers/UR Companies
are inappropriately applying PPO discounts to Workers' Compensation treatment billings.
Complete this survey to provide your input.  Individual information will be kept confidential.

*1.Contact Information(Required.)

Name of Person Completing Survey

Company

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.Orthopaedic Subspecialty/Medical Specialty

3.Our practice is experiencing the following problems with Workers' Compensation payors/self-insured employers applying inappropriate PPO discounts: (check all that apply)

Applying incorrect PPO discounts to treatment bills.

Applying a PPO discount for a carrier unrelated to the claim.

Applying multiple discounts on a single bill.

Applying a PPO discount to Medical-Legal evaluations.

Other Discounting Problems (please specify)

4.List the names of the Workers' Compensation payors/self-insured employers or their agents who are applying these inappropriate discounts?  (List the name of all companies involved).

5.Are you receiving calls from third party entities wanting to negotiate a further discount after the service has been performed?

Yes

No

6.If yes, list the name of the third party entity and name of the Workers' Compensation payor/self-insured employer they represent.

7.THE MOST IMPORTANT QUESTION.
We need to provide documentation of these problems to DWC, URAC, and members of the State Legislature.  Please email EOBs showing these inappropriate PPO discounts on your Workers' Compensation billings.  Send your examples to:  admin@coa.org  Include a short description as to the problem with each billing.  Your examples are needed by June 15.  

8.Thank you for responding to this survey and providing your input.