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Travelers Insurance may be engagning in a "silent PPO" scheme in Illinois.
Investigation Source
- Illinois
Investigation Scope
Category Information
Investigation Topics
- Misrepresentation
- Healthcare Services
Products or Services
- Health Insurance
- Doctors
- Hospitals
- Healthcare Organizations
- Reimbursement By Insurance Companies
Injury Type
- Monetary Loss
Investigation Details
Investigation and pending class action against Travelers Insurance for Traveler's long standing treatment of certain medical providers.
According to the class action lawsuit, Travelers has engaged in a silent Preferred Provider Organization scheme. In a PPO, insurance companies provide financial incentives to encourage patients to seek treatment from the preferred or in-network providers. Financial incentives include, for example, reduced co-payments or greater benefit coverage for seeking treatment from preferred or in-network providers. A "silent PPO" occurs when an insurance company breaches its obligation to refer patients to medical providers but still take the discounts the medical providers' bills. As a result, the medical provider loses revenues without gaining patients, receiving nothing in exchange for the reduced bills.
According to the class action lawsuit, Travelers has engaged in a silent Preferred Provider Organization scheme. In a PPO, insurance companies provide financial incentives to encourage patients to seek treatment from the preferred or in-network providers. Financial incentives include, for example, reduced co-payments or greater benefit coverage for seeking treatment from preferred or in-network providers. A "silent PPO" occurs when an insurance company breaches its obligation to refer patients to medical providers but still take the discounts the medical providers' bills. As a result, the medical provider loses revenues without gaining patients, receiving nothing in exchange for the reduced bills.
Defendant Details
| Name (Stock Symbol) | Brief Description |
|---|---|
| Travelers Companies, Inc., The (TRV) | The Travelers Companies, Inc., a holding company, provides various commercial and personal property and casualty insurance products and services to businesses, government units, associations, and individuals primarily in the United States. |