Is CAI A “Silent” Or “Blind” PPO?
A. No. A “silent” or “blind” PPO or repricing organization provides discounts on medical claims without meeting the requirements of their PPO partners (example; the contract with a PPO requires that a minimum of 10% benefit differentials must be in place to access a discount, however the vendor takes the discount on a patient who is not proactively directed to the provider for care). CAI only uses those PPOs that BY CONTRACT authorize us to access discounts when the patient is not directed to the provider for care or otherwise meets the requirements of the provider. Typically, we can access 5-13 Supplemental PPOs in each state. There are some organizations that do engage in “blind discounting” behavior and we caution companies to confirm their vendors contractual relationships with the PPOs or providers. Taking discounts inappropriately can lead to provider disputes, lost discounts and employee dissatisfaction.
