The language in your preferred provider organization ("PPO") contract may differ from the terms of your benefit plan document. What’s more, when this contradiction is brought before a Court, many PPO Administrators and in-network providers have prevailed in their attempt to enforce their contract over the plan document. On top of paying unwanted claims, plans and TPAs that sign PPO agreements may need to forgo their right to audit claims and risk breaching the network agreement if they try to apply plan-based price ceilings or take too long in accurately reviewing the claims. Worst yet, the TPA itself may be deemed a fiduciary.

Join The Phia Group's CEO Adam V. Russo, Esq. and Senior Vice President Ron E. Peck, Esq., as they discuss the evolution of the PPO, expose the issues existing between benefit plans and the PPOs, explain what to watch for when reviewing a PPO agreement, and share strategies to enforce the terms of the plan document in the face of contradictory network provisions.