For many years, health insurers and healthcare have suspected that automobile insurance carriers have systematically avoided payment despite the coordination of benefits laws, and the practices of these companies reveal their passive strategies to avoid payment for their contractual obligations.
As a result, despite best efforts of payment integrity and COB teams, including using TPL/Subrogation services, the most diligent health plans and healthcare providers find only find approximately 78% of TPL involving motor vehicle accidents.
For example, most auto insurance companies require their insureds to report any accident or claims within 24 hours; otherwise, the carrier may not cover the accident.
To assess their potential financial obligation for medical expenses, the auto carriers investigate the circumstances of the accident and all parties involved.
The auto carriers realized that many healthcare providers do not understand third-party liability and coordination of benefits laws, and some auto insurance companies choose not to disclose their primary position for the liability for medical expenses related to the accident. Instead, the auto carriers allow providers to bill health insurance as primary and let the process play out.
Despite the coordination of benefits rules/laws, auto insurance companies have saved hundreds of millions of dollars annually by systematically avoid payment by allowing health insurance to pay the claim or to appropriately reject the claim, leaving the provider to try to figure out how to get paid.
In Florida for example, most auto insurers require healthcare providers to submit their claims to auto insurance within 35 days of the accident to qualify for payment for the medical care provided. If the providers miss this timely filing requirement, they bill the health insurance, who often pay as primary.
The primary reasons the healthcare providers do not bill auto insurance for medical care resulting from an auto accident include the following:
1. No auto insurance information provided at the time of medical care.
2. No auto insurance eligibility database and no universal process exists to determine coverage.
3. Healthcare providers do not know that auto insurance may also provide medical benefits for other parties to the accident who were not in the vehicle (e.g., pedestrians).
TPL Claims, LLC has been addressing these unfortunate issues since 2011, working with healthcare providers and health insurance companies to discover payments made in error and recover unpaid automobile insurance liability for medical services related to auto accidents. TPL Claims, LLC now leverages over a decade of accumulated experience, knowledge, and proprietary processes as TPL Claims Detective™.
The important news is that TPL Claims Detective™ help health plans and healthcare providers solve the problem that they didn’t know they have by finding the 22% of missed TPL cases, even after the others have completed their research!
TPL Claims Detective performs better than others by supplementing third-party liability discovery processes with additional, proprietary data sources. TPL Claims Detective also uses intelligent filtering, forensic matching, and clinical algorithms to discover more cases across all data sources focused on motor vehicle accidents and auto insurance coverage.
Using its proprietary logic and processes, TPL Claims Detective has already discovered over $1.6B in payments avoided by auto insurers and paid in error by health insurers.
Now you know! TPL Claims Detective can help you solve the problem that you didn’t know that you have!
Contact us to find out how much TPL Claims Detective can help you discover and recover!
