What Docs Need to Know About Three Rivers Network

What Every Doc Needs to Know About Three Rivers Network and PIP insurance.

Safeco, USAA, and some other PIP insurance companies have affiliated themselves with Three Rivers Network to further discount your medical bills! Be on the look out for Explanation of Benefits that say “PPO reductions based on Three Rivers Network agreement”.

There is a similar company called “Integrated Health Plans” that is doing the same thing- helping reduce your bills.

Here is an example about what is happening:
In one case, an MRI center billed $1,600. PIP normally would have allowed about $1,100.00 (at 200% of Medicare) and would have paid about $880.00 (80% of 200% Medicare). Because this MRI center was contracted with Three Rivers Network, they were paid 80% of the amounts contracted with Three Rivers Network. Instead of getting paid $880.00 they were paid $675.00!

that amount which wou.pays them $1,280 per MRI (PIP pays 80% of the amount billed). In this case, the provider contracted with IHP (a company similar to Three Rivers) to a 75% reduction in their bill which brings the bill down to $1,200. Since PIP pays 80% of the amount billed, this provider was only paid $960.00! That’s a $320 difference! When I talked to the MRI center they could not find any benefit to being a member of Three Rivers.

Three Rivers contracts with doctors and contains contract language that basically allows other insurance companies (like PIP insurance companies) to piggy back off of the reductions that Three Rivers contracts for. At this point, I don’t know if Three Rivers has any individual members (humans) of its own. I think (and I haven’t been able to verify this) that Three Rivers only has instutitions (insurance companies) as clients.

Three Rivers was accused by the AMA of using shady methods to get doctors to contract with them via fax by requesting a W9.

Every medical provider will need to assess the PROS and the CONS of having a contract with Three Rivers Network. You should consult with your own attorney before choosing to join or leave the Three Rivers Network. The above post is an opinion of the author


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