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One of the worst problems facing providers is silent yet possibly financially dangerous. As the name suggests, silent PPOs often go undetected and have the potential to take a significant bite out of your earnings without so much as a peep from the provider. Silent PPO payer arrangements offer patients discounted fees without requiring them to access provider services. Under such arrangements, a third party obtains a database of preferred provider rates from a managed care organization (MCO) or discount insurance broker. The MCO sells or rents its PPO provider network to the third party or insurance broker.