AmTrust -  IBR Hall of Shame

AmTrust - IBR Hall of Shame

Below, we document the flouting of workers’ compensation law by AmTrust North America (AmTrust), and its continued refusal to reimburse a provider despite being ordered to do so by Maximus. In this latest installment of the IBR Hall of Shame, we chronicle an all-too-familiar payment marathon that starts when a provider “wins” an Independent Bill Review (IBR). This particular case is but one of innumerable examples of claims administrators’ blatant disregard for California law, and their reliance on a state workers’ compensation system that repeatedly fails to protect providers who shoulder the responsibility for treating injured workers.

We often hear employers bemoan the difficulties faced by injured workers in their attempts to obtain treatment for work-related injuries. At a conference we attended last year, employers stated again and again that they are willing to pay top dollar for care for their employees. However, as we repeatedly explained to these employers, their willingness to pay stood in direct contrast to the frequently obstructive behavior of their hired third party administrators and workers’ comp insurers, whose priorities seem more geared toward denying payment rather than securing care.

For employers, the kind of provider payment abuse documented below exemplifies the reason many providers refuse to treat injured workers.

AmTrust Fails VForce Staffing Solutions

AmTrust, acting on behalf of the employer Accuire LLC dba VForce Staffing Solutions, refuses to pay a provider the amounts that were due when the provider prevailed in a recent IBR case. The efforts, documented below, to collect this payment demonstrate, yet again, how the provider must shoulder all the responsibility for collecting payment. Multiple phone conversations and voicemails, careful documentation, and climbing stress levels are par for the course for providers who seek to induce a claims administrator to meet its mandated obligations.

In this instance, Maximus agreed with the provider that they received incorrect reimbursement and accordingly ordered AmTrust to reimburse the provider for both the additional reimbursement due and the $180 IBR fee paid by the provider to file the IBR. According to California regulations, AmTrust must remit said payment to the provider within 45 days of the IBR decision. In this instance payment was due 7/12/2020.

As of 9/15/2020, the IBR Additional Reimbursement and IBR Filing Fee are 65 days past due.

Despite an IBR decision awarding the provider the correct reimbursement, despite numerous voicemails and conversations with AmTrust representatives, AmTrust continues to refuse to properly reimburse the provider for an Original bill electronically submitted on 12/18/2019.

To highlight just the latest of the frustrating conversations, on 9/2/2020 a DaisyCollect representative spoke to the AmTrust adjuster who gave a rationale for the denial that was not only non-compliant but, frankly, jaw-dropping:

Spoke with adjuster RXXXX and they explained that they do not think the provider is on their MPN. According to the adjuster, AmTrust denies provider’s services and the IBR does not apply.

DaisyCollect left five voicemails and had four conversations with AmTrust from 7/13/2020 through 9/2/2020.

Claims Administrator: AmTrust North America

Employer: Accuire, LLC DBA Vforce Staffing Solutions

Date

Days Payment Overdue

Action

Action Count

Notes

05/28/2020

0

Maximus issued Overturn decision

N/A

Maximus determined additional reimbursement is warranted.

07/12/2020

0

Additional Revenue $174.82 & $180 IBR Filing Fee due

N/A

Additional revenue plus IBR Filing Fee due 45-Days after Maximus Final Determination Letter.

07/13/2020

1

DaisyCollect called AmTrust

1st conversation

Obtained adjuster name and contact information.

07/13/2020

1

DaisyCollect left voicemail with adjuster

1st voicemail

Called RXXXX at XXX-XXX-XXXX and left a voicemail in regards to the missing IBR payments. Asked for a return call.

07/15/2020

3

DaisyCollect left voicemail with adjuster

2nd voicemail

Left second voicemail with adjuster after no response received.

07/22/2020

10

DaisyCollect left voicemail with adjuster

3rd voicemail

Left third voicemail with adjuster after no response received.

07/23/2020

11

DaisyCollect called AmTrust

2nd conversation

Obtained the supervisor’s name and contact information.

07/23/2020

11

DaisyCollect left voicemail with adjuster’s supervisor

4th voicemail

Called supervisor GXXXX at XXX-XXX-XXXX. There was no answer so I left a voicemail in regards to the payments and asked for a return call.

07/28/2020

16

DaisyCollect called adjuster’s supervisor

3rd conversation

Supervisor picked up and explained they don't have information about this IBR payment. They took my contact info down and said they will tell the adjustor, RXXXX, to give me a call back.

08/18/2020

37

DaisyCollect left voicemail with adjuster’s supervisor

5th voicemail

Left second voicemail with adjuster’s supervisor after no response received.

09/02/2020

52

DaisyCollect called adjuster

4th conversation

Spoke with adjuster RXXXX and they explained that they do not think the provider is on their MPN. According to the adjuster, then AmTrust denies provider’s services and the IBR does not apply. Adjuster needs the determination letter, reports and all billing faxed to them. Adjuster will look into this and give an update by the end of next week.

09/02/2020

52

DaisyCollect faxed adjuster

1

DaisyCollect faxed Maximus Final Determination Letter to adjuster.

09/09/2020

59

DaisyCollect filed Audit Complaint

1

DaisyCollect filed Audit Complaint for AmTrust’s failure to pay IBR fees despite multiple attempts to collect.

Despite our continued efforts, our client remains unpaid. And this is just one instance among many, in a practice context where countless providers have barely enough administrative staff to file bills compliantly. Most providers do not have the resources or staff, like we do, to doggedly chase down missed payments. So when the claims administrator ignores their duty to pay up, or actively resists paying, it is the claims administrator that wins and the provider who suffers.

Does Vforce Staffing Solutions know this is how their administrators and workers' comp insurers are managing these workers' comp claims?

If your practice is experiencing similar roadblocks to collecting mandated payment, we recommend filing an Audit Complaint. They are effective and anonymous (as long as you check the right box). For DaisyBillers, we’ve made it incredibly easy to file through DaisyBill; for non-DaisyBillers, watch this short webinar that explains the audit process -- but remember to use the Audit Complaint form that was updated in 2019.


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