Adminsure is a prime example of why providers hesitate to treat injured workers.

In multiple cases, Adminsure compliantly sent an electronic Explanation of Review (e-EOR) in response to a provider’s electronic bill (e-bill). However, daisyCollect cannot confirm that the provider received the actual payments…and neither can Adminsure.  

As our intrepid daisyCollect agents discovered, calling Adminsure to investigate missing payments and obtain paper copies of the EORs is a plunge down a bureaucratic rabbit hole from which few could emerge with their faith in humanity intact.

As the ordeal below demonstrates, the ineptitude and sheer friction on display at Adminsure are mind-bending, even by workers' compensation standards.

Read on to see the time-consuming and patience-testing nightmare Adminsure inflicts on providers seeking reimbursement.

Adminsure’s Provider Portal Runaround

On behalf of a provider client, daisyCollect investigated several bills for which Adminsure had managed to send e-EORs, but for which there is no indication the provider received:

• Checks for payment, and
• Paper versions of the EORs in question

When our agents called Adminsure to inquire about a specific payment, the TPA’s representatives instructed us to use Adminsure’s online provider portal to check the claim status.

We politely reiterated that the claim’s status was not in question. Instead, we simply needed confirmation that Adminsure had actually delivered payment. The Adminsure agent again directed us to the TPA’s online portal, which did not tell us if the check Adminsure (allegedly) sent actually made it to the provider.

During our next call, an Adminsure representative was able to determine that Adminsure had issued a check, but couldn’t confirm whether it had been cashed.  The rep also claimed to have no ability to send a copy of the paper EOR.

When we informed the Adminsure rep that several dozen bills were missing checks and paper EORs, Adminsure instructed our agent to email another department with the details of all the affected bills. We assembled the requested information and sent an email requesting that the missing checks be reissued.

In response, we received an automatic reply from Adminsure directing us to…their online portal.

Apparently, this is what Adminsure means by its website’s tagline: “Humanizing the Claims Process.”

Ultimately, someone at Adminsure replied to our email by sending images of the missing paper EORs (as opposed to usable files, such as PDFs) pasted into the body of the email.

The email provided no information regarding the status of the missing checks, which remain at large as of this writing.

Adminsure’s Compliance Theater

Adminsure technically checks the compliance boxes by sending e-EORs.

However, when it comes to actually paying providers (or confirming that payment occurred) Adminsure subjects providers to a Kafkaesque fog of non-answers.

Adminsure makes it painfully obvious why so many doctors are choosing not to treat injured workers. When simple payment inquiries involve this much needless, circular administrative friction, why would any rationally self-interested provider take on workers’ comp patients?

Without an actual check, a compliant e-EOR is meaningless. Adminsure’s compliance theater costs providers in wasted time, missing reimbursements, and revenue management chaos.

Until regulators start enforcing technical compliance and payment accountability, Adminsure and other TPAs will continue to abuse providers while maintaining a veneer of payment.

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