Payment processing vendor ECHO Health is withholding Explanations of Review from California workers' compensation providers. ECHO then uses the missing EORs as bait to compel providers onto its website, which forces the provider through an aggressive, extended push to register for ECHO’s Medical Payment Exchange (MPX) platform.

ECHO recently mailed a check on behalf of Midwestern Insurance Alliance without the legally required EOR. Instead, ECHO sent the check with instructions for the provider to retrieve the EOR (which ECHO terms an “Explanation of Payment” or “EOP”) by visiting echochecks.com, where page after page cajoles the provider into signing up for MPX.

Arguably, the website gives the impression that the provider has no choice but to sign up for MPX to obtain an EOR. While the website does (eventually) disclaim that the provider can call ECHO to receive an EOR and opt out of MPX, the provider has to click through several pages of pushy advertising to reach those instructions.

California law and regulations require Midwestern to issue a timely EOR in response to every bill. Its vendor, ECHO, has no right to force a provider to navigate a marketing site or make a phone call to chase down a document to which they are legally entitled.

All California providers treating injured workers should read this article carefully and be aware of ECHO’s tactics. This is the kind of administrative ordeal providers endure simply to participate in the state’s anarchic workers’ comp system.

The Bait: Payment Without the EOR

The provider submitted a compliant bill to Midwestern. ECHO, acting on Midwestern's behalf, mailed a paper check.

But instead of an EOR, the provider received an instruction sheet with the heading: "Looking for your Explanation of Payment (EOP)? It's waiting online. Retrieve it now!"

The instructions direct the provider to visit the ECHO site and enter their practice’s Tax ID number and the check number, neglecting to mention that doing so enrolls the provider into MPX.

The instructions also entices the provider with allegedly faster payments "from over 200+ health insurance companies," foreshadowing the hard sales pitch they’re about to endure.

ECHO Blocks EOR With Marketing Funnel

At echochecks.com, the provider sees two options: cancel a virtual card payment, or "get the explanation of payment documentation" for a paper check. Clicking the paper-check option takes the provider to a second page, which instructs the provider to select a new preferred payment method:

“To receive your explanation of payment documentation, you must select your new preferred payment method.”

The two available "new preferred payment methods" are paper checks or Electronic Funds Transfer, both through MPX. There is no option to simply retrieve the EOP for the check the provider already received.

The Hook: Entering Information Enrolls the Provider in MPX

Choosing the paper option leads to a page titled "We Heard You — You Like Paper Checks," which extolls the virtues of MPX, promising faster payments and printable EOPs.

The page instructs the provider to enter their Tax ID and check number to (finally) get the EOP they came for:

“Simply enter your Tax ID and the check number you received to register with us to receive your current EOP and faster payment!”

Entering the Tax ID and check number automatically enrolls the provider into MPX.

Arguably, the page gives the impression that doing so is the only way to retrieve the EOP. However, below the registration fields, a disclaimer instructs that there is a way for the provider to obtain the EOP without signing up for MPX:

“Maybe MPX is just not for you. We will assist you in retrieving your EOP and return you to the mail process. Call us at 888-865-8767 and provide your Tax ID and Enrollment code.”

The provider only sees this disclaimer after clicking through several pages of MPX marketing materials and reading past MPX registration fields that arguably appear mandatory. ECHO phrases its willingness to “assist” the provider over the phone as a service, rather than compliance with the state legal requirement to provide an EOR.

ECHO’s Pitch Is Midwestern’s Non-Compliance

Nothing in California law or regulations supports the notion that a payer’s vendor can force a provider through a lengthy marketing funnel or require a phone call to obtain an EOR.

California Labor Code Section 4603.2 requires the payer to deliver the EOR with payment within 45 days of receiving the bill (60 days for a government employer). The California Division of Workers’ Compensation’s Medical Billing and Payment Guide Section 6.2 specifies acceptable EOR delivery methods including first-class mail and fax (or delivery of an electronic EOR if the provider submitted the bill electronically).

If a provider refused to engage with ECHO’s website or place a call, and no EOR arrived, Midwestern Insurance Alliance, which is legally responsible for ECHO’s actions, has committed a violation.

Failing to issue the EOR also potentially robs the provider of their right to appeal denials or reductions. Providers must include EORs with timely Second Review appeals and requests for Independent Bill Review. If ECHO’s marketing tactics keep EORs out of the provider’s hands beyond the deadlines to file appeals or IBR requests, they cannot pursue a payment dispute.

ECHO’s payment portal trap is not an error. It’s a deliberate ploy to use EORs as leverage to push providers into a platform that profits ECHO. California law requires EORs; it does not authorize their use as a sales tool.

Insurers are free to use payment processing vendors, but those vendors must comply with state requirements: send timely EORs using the allowable delivery methods, without conditioning delivery on the provider going down an online rabbit hole or placing a phone call.

ECHO’s website promises “payments simplified.” Rather than putting providers through this rigamarole, following the law and issuing timely EORs would arguably be much simpler.

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