We continue to look at the misbehavior of ESIS, which yesterday entered the IBR Hall of Shame for its deplorable treatment of a provider who prevailed in two Independent Bill Reviews (IBRs). This article goes into the gory details and infuriating sequence of (non)communications. For background, see Part 1: Is ESIS Gaming the California Workers' Comp System?
In short, after the provider submitted IBRs, ESIS eventually correctly reimbursed the provider for the disputed amounts. Except the two bill payments sent to the provider did not include reimbursement of the two $180 IBR fees that the provider paid to file the IBRs with Maximus. Below, we document the fruitless, infuriating, and numerous voicemails and emails (18 attempts and counting) which we have so far endured to try to get ESIS to verify payment of the two IBR fees owed. That ESIS’ systems seem unable to cope with such a simple request should give pause to the employers who use ESIS’ services.
The injured worker was employed by ABM Industries, Inc. which is a self-insured California employer that uses ESIS as its Third Party Administrator (TPA). For two separate evaluations of an ABM-employed injured worker, ESIS incorrectly denied reimbursement for the authorized services.
In both cases, Maximus ruled against ESIS and awarded payment to the provider. Labor Code 9792.5.14. directs ESIS to reimburse the provider the $180 filing fee when the claims administrator’s bill review decision is overturned by IBR. The law is clear. Yet, the reality is that claims administrators ignore the law with impunity.
Below, we share the extensive, and so-far Sisyphean, efforts made by DaisyBill to contact ESIS and ascertain the status of the $180 fees due to the provider. Note: ABM Industries should pay attention to the way in which ESIS manages simple phone calls from providers who treat ABM’s injured employees -- and question whether ESIS is treating ABM’s injured employees in a similarly dismissive fashion.
3/12/2020 - Provider Files IBR with Maximus
6/1/2020 - ESIS Payment Date $687.50
7/24/2020 - Maximus Decision Date
6/26/2020 - Provider Files IBR with Maximus
9/14/2020 - ESIS Payment Date $875.00
10/29/2020 - Maximus Decision Date
One thing to note regarding IBR fees is that, once an IBR has been filed, it doesn’t matter if a disputed amount was paid before or after Maximus’ determination: if the provider prevails, as in these cases, the provider is owed the $180 that the provider already paid for the IBR filing fee.
Bill |
Date |
Days Payment Overdue |
Action |
Action Count |
Notes |
#1 |
06/01/2020 |
0 |
ESIS issued payment for disputed amount |
N/A |
ESIS paid disputed amount before Maximus issued the Final Determination Letter. |
#1 |
07/24/2020 |
0 |
Maximus issued Overturn decision |
N/A |
Maximus determined additional reimbursement is warranted. |
#1 |
09/07/2020 |
0 |
Due: Additional Revenue $687.50 & $180 IBR Filing Fee |
N/A |
Additional revenue plus IBR Filing Fee due 45-Days after Maximus Final Determination Letter. |
#1 |
09/10/2020 |
3 |
DaisyCollect called ESIS |
1st call attempt |
No answer. |
#1 |
09/15/2020 |
8 |
DaisyCollect called ESIS |
1st conversation |
Obtained the adjuster name and contact info |
#1 |
09/15/2020 |
8 |
DaisyCollect called adjuster |
1st voicemail |
Called adjuster XXXXXX and left a voicemail requesting the status of the IBR Filing Fee payment.
$180 IBR Filing Fee remains due. |
#1 |
09/29/2020 |
22 |
DaisyCollect called adjuster |
2nd voicemail |
Called adjuster XXXXXX and left a voicemail requesting the status of the IBR Filing Fee payment. |
#1 |
10/07/2020 |
30 |
DaisyCollect called adjuster |
3rd voicemail |
Called adjuster XXXXXX and left a voicemail requesting the status of the IBR Filing Fee payment.
|
#1 |
10/14/2020 |
37 |
DaisyCollect called ESIS |
2nd conversation |
Called ESIS a second time to find the contact info for the adjuster’s supervisor. Claims representative was then unable to locate the patient file. |
#1 |
10/22/2020 |
45 |
DaisyCollect called adjuster |
4th voicemail |
Called adjuster XXXXXX and left a voicemail requesting the status of the IBR Filing Fee payment. |
#1 |
11/04/2020 |
58 |
DaisyCollect called ESIS |
3rd conversation |
Spoke with claims representative to obtain contact information for adjuster’s supervisor. |
#1 |
11/04/2020 |
58 |
DaisyCollect called adjuster’s supervisor |
5th voicemail |
Called supervisor XXXXXX, but they did not answer, so left a voicemail requesting the status of the IBR Filing Fee payment. |
#1 |
11/16/2020 |
70 |
DaisyCollect called adjuster’s supervisor |
6th voicemail |
Left voicemail requesting the status of the IBR Filing Fee payment. |
#1 |
12/01/2020 |
85 |
DaisyCollect called adjuster’s supervisor |
7th voicemail |
Left voicemail requesting the status of the IBR Filing Fee payment. |
#1 |
12/24/2020 |
108 |
DaisyCollect called adjuster’s supervisor |
8th voicemail |
Left voicemail requesting the status of the IBR Filing Fee payment. |
#1 |
12/24/2020 |
108 |
DaisyCollect called adjuster |
9th voicemail |
Left voicemail requesting the status of the IBR Filing Fee payment. |
#1 |
01/06/2021 |
121 |
DaisyCollect called adjuster’s supervisor |
10th voicemail |
Left voicemail requesting the status of the IBR Filing Fee payment. |
#1 |
01/20/2021 |
135 |
DaisyCollect called adjuster’s supervisor |
11th voicemail |
Left voicemail requesting the status of the IBR Filing Fee payment. |
Bill |
Date |
Days Payment Overdue |
Action |
Action Count |
Notes |
#2 |
09/14/2020 |
0 |
ESIS issued payment for disputed amount |
N/A |
ESIS paid disputed amount before Maximus issued Final Determination Letter. |
#2 |
10/29/2020 |
0 |
Maximus issued Overturn decision |
N/A |
Maximus determined additional reimbursement is warranted. |
#2 |
12/13/2020 |
0 |
Additional Revenue $875.00 & $180 IBR Filing Fee due |
N/A |
Additional revenue plus IBR Filing Fee due 45-Days after Maximus Final Determination Letter. |
#2 |
12/17/2020 |
4 |
DaisyCollect called adjuster’s supervisor |
1st voicemail |
Left message with adjuster's supervisor XXXXXX requesting the the status of the IBR Filing Fee payment.
$180 IBR Filing Fee remains due. |
#2 |
01/06/2021 |
24 |
DaisyCollect called adjuster’s supervisor |
2nd voicemail |
Left message requesting the status of this payment. |
#2 |
01/21/2021 |
39 |
DaisyCollect called adjuster’s supervisor |
3rd voicemail |
Left message requesting the status of this payment. |
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