PIP PPO

As early as 1993, PIP Insurers began utilizing PPO arrangements to reduce PIP payments to health care providers.  Since their introduction into the PIP market, PIP PPO arrangements have taken many forms.  Most notable are the arrangements proliferated by Beechstreet, CCN and Medview.  Although voluntary PIP PPO's are allowed by the PIP Statute, Florida courts have ruled that they can only be utilized if the PIP carrier complies with specific requirements of the Statute.  We have reviewed the practices of PIP carriers such as Allstate, Progressive and Nationwide and found that in most cases they have failed to issue a PIP PPO policy to their insured.  In addition, these PIP PPO's are actually Silent PPO's because they have failed to give their insured a list of contracted providers.  In short, almost all of these PIP PPO reductions are illegal and the reductions associated with them are recoverable.

Since 1993, numerous PIP insurers have illegally reduced provider's PIP bills pursuant to these Silent PPO Scheme.  Within the past three years alone major PIP insurance companies such as Allstate, Progressive, Nationwide and Liberty Mutual have utilized these illegal PIP PPO's to shave tens of millions of dollars from provider payments.  Currently, over 100 hospitals and thousands of providers throughout Florida are affected by these illegal reductions. 

The illegal reductions associated with PIP PPO's are substantial.  It is not unusual to see reductions of 30% - 50% per bill.  It is interesting to note that EOB's from Allstate do not even show the actual amount billed but rather the reduced amount.

If your practice has experienced problems with PIP PPO's such as Beechstreet, CCN and Medview we would be happy to meet with you to discuss those issues in greater detail.