OUR COLLECTION PROCESS IN A NUTSHELL

What We Do in a Nutshell
For close to 15 years our law firm has helped over 350 hospitals, diagnostic centers, physician practices, and emergency rescue providers collect over $20 million in unpaid and underpaid insurance receivables – in most cases with no fee to the client and no percentage of the recovery charged.

How does the process work?
In short, our office has an attorney review each of your P.I.P. files (one by one) going back 5 YEARS to determine if you were underpaid or wrongly denied by the P.I.P. insurer. We do the work for you reviewing each and every auto account receivable to confirm proper payment. Files remain right in your office and any claims we identify as payable we digitally scan with portable equipment that we bring. From those scanned files we create a list for your review and approval to pursue for collection.

What happens once files are approved to pursue?
The process is simple. We first send a written demand letter to the insurer notifying them of the claim dispute and advising them that they have 30 days to pay the claim (along with the applicable interest and penalties) or a lawsuit will be filed. If the insurer chooses to promptly resolve the demand (currently approximately 80%-90% of our claims resolve pre-suit) then the insurer pays no attorney’s fees and costs – it is only responsible for payment of the payment of the medical benefits plus postage, interest and a small penalty of 10% of the overdue amount (Our payment is the penalty and interest only).

So take, for example, a $1,000.00 claim that is 1 year overdue – here is how the settlement would break down:
1) $1,000.00 paid to the medical provider – we take no cut of the recovery!!!
2) $100 penalty (10% penalty paid by insurer in addition to what they owe you) – paid to us as attorney’s fees.
3) $60 interest (6% statutory interest paid by insurer in addition to what they owe you) – paid to us as attorney’s fees. Insurer must also reimburse our postage costs.

TOTAL ON THIS $1000.00 CLAIM EXAMPLE = $1000 to you. $160 to us.

What Happens If They Don’t Pay Your Demand?
Florida law provides stiff penalties for insurers who do not timely pay claims. Specifically, an insurer may be liable for payment of the consumer or medical provider’s attorney’s fees and costs if a suit is filed and even a nickel is recovered. So taking our example above, if the insurer refuses to pay the $1,000 demand and suit is filed the insurer will be liable for the $1,000 plus interest plus attorney’s fees and costs if it loses. Attorney’s fees and costs generally start at $2500 and reach $400 per hour or more if they continue to fight. So, there is a strong incentive for the insurer to resolve the claim for the $1,160.00 demanded ($1,000 plus $160 penalty + interest) rather than risk paying thousands (even tens of thousands) more if it was wrong. The key is case selection – which is why we pride ourselves as being the only firm we have encountered with 2 dedicated intake attorneys reviewing new files to determine if they are proper cases.

We have lawyers and collection people -- aren’t they doing this?
The short answer is – most likely – NO. Most facilities use the following flawed collection process:
1) Bill the primary insurance (P.I.P.);
2) If P.I.P. doesn’t pay bill the secondary insurance;
3) If the secondary insurance doesn’t pay – after 90 days send it to a collection company who takes a hefty cut of the recovery.

What’s the flaw?
In short, you’re ignoring the two deep pockets (PIP and health insurance) to pursue the patient who likely has no money or, if he does, is rightly saying “I have 2 insurances – GO AFTER THEM!”

How Do We Fix It?
1) Change your thought process by fully pursuing P.I.P. (Don’t accept that denials and reductions are right).
2) Once you have fully pursued P.I.P. that opens collections to your secondary insurer.
3) Complete payment from P.I.P. and the secondary insurance then leaves a smaller co-payment and deductible balance, which is easier for the collection staff or collection company to recover.

What about HIPAA?
Our firm utilizes HIPAA independent contractor agreements and works as an arm of your collection people – maintaining full compliance with all requirements of the Federal HIPAA law. Remember, HIPAA does not bar you from collecting your balances.

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