Ask yourself — what happens if you’re a year late paying a bill?
Your credit score tanks? Your car is repossessed? Your home foreclosed on?
In most walks of life, simply neglecting to pay what’s owed has consequences. But in California workers’ comp, when a self-insured employer and its third party administrator (TPA) fail to reimburse a provider for treating an injured employee, there is a complete absence of accountability.
Take ESIS, for example. In July of 2020, California Independent Bill Review (IBR) overturned ESIS’ denial of a provider’s reimbursement for treating an ABM Industries employee. By law, ESIS owed the provider both the disputed reimbursement amount and the $180 filing fee the provider paid to request IBR.
But 350 days after the due date, ESIS has failed to acknowledge reimbursing the provider the $180 IBR filing fee.
Since January of this year, we’ve chronicled ESIS’ failure to pay the IBR fee for this ABM Industries bill.
According to the California Office of Self Insurance Plans (OSIP), ABM Industries is a self-insured employer. Per the OSIP website, employers are allowed to self-insure as an alternative to purchasing workers’ comp insurance:
To manage their workers’ comp claims, self-insured employers often turn to TPAs like ESIS. Unfortunately, TPA’s may fail to properly reimburse the providers who treat the employer’s workers.
ESIS twice denied payment to the provider — once for the original bill, and again after the provider submitted a Second Review appeal. Subsequently, after the provider paid $180 to file for IBR, ESIS paid the disputed reimbursement amount before California issued the IBR ruling.
Not every provider is willing to pay $180 and go through the hassle of IBR. We find it suspicious when a claims administrator apparently (and very suddenly) experiences a change of mind once the provider requests IBR.
While we cannot know ESIS’ motivations, we can’t help but wonder: did ESIS, on behalf of ABM Industries, simply bet that the provider wouldn’t appeal the incorrect payment — and double down on that bet after the Second Review appeal?
If so, ESIS lost that wager — and it’s well past time to settle up.
The table below documents the (herculean) efforts by DaisyCollect agents to collect the IBR filing fee on behalf of the provider who treated the ABM employee. The fact that ESIS has yet to acknowledge paying this fee should horrify ABM Industries, California legislators, providers, and every employer or insurer that uses ESIS as its TPA.
To date, these efforts include:
As a self-insured employer, ABM Industries is obligated to adhere to all California workers’ compensation laws, regulations and rules. To that end, maybe it’s time for ABM to rethink their choice of TPA.
Date |
Action |
Action Count |
Notes |
DAYS PAYMENT OVERDUE |
06/01/2020 |
ESIS issues payment for disputed amount |
N/A |
ESIS paid before the IBR ruling was issued. |
0 |
07/24/2020 |
IBR decision overturns ESIS denial |
N/A |
IBR mandates ESIS remit disputed payment and $180 IBR filing fee to the provider. |
0 |
09/07/2020 |
Payment from ESIS due |
N/A |
Payment is due 45 days from the date of the IBR Final Determination letter. |
0 |
09/10/2020 |
DaisyCollect calls ESIS |
1st call attempt |
No answer |
3 |
09/15/2020 |
DaisyCollect calls ESIS |
1st conversation |
Obtained adjuster name and contact info |
8 |
09/15/2020 |
DaisyCollect calls ESIS claims adjuster |
1st voicemail |
Left voicemail requesting status of IBR filing fee payment. |
8 |
09/29/2020 |
DaisyCollect calls ESIS claims adjuster |
2nd voicemail |
Left voicemail requesting status of IBR filing fee payment. |
22 |
10/07/2020 |
DaisyCollect calls ESIS claims adjuster |
3rd voicemail |
Left voicemail requesting status of IBR filing fee payment. |
30 |
10/14/2020 |
DaisyCollect calls ESIS to request contact info for claims adjuster’s supervisor |
2nd conversation |
Claims representative unable to locate patient file |
37 |
10/22/2020 |
DaisyCollect calls ESIS claims adjuster |
4th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
45 |
11/04/2020 |
DaisyCollect calls ESIS to request contact info for claims adjuster’s supervisor |
3rd conversation |
Claims representative provided contact information for adjuster’s supervisor |
58 |
11/04/2020 |
DaisyCollect calls adjuster’s supervisor |
5th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
58 |
11/16/2020 |
DaisyCollect calls adjuster’s supervisor |
6th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
70 |
12/01/2020 |
DaisyCollect calls adjuster’s supervisor |
7th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
85 |
12/24/2020 |
DaisyCollect calls adjuster’s supervisor |
8th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
108 |
12/24/2020 |
DaisyCollect calls ESIS claims adjuster |
9th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
108 |
01/06/2021 |
DaisyCollect calls adjuster’s supervisor |
10th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
121 |
01/20/2021 |
DaisyCollect calls adjuster’s supervisor |
11th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
135 |
2/1/2021 |
DaisyCollect calls adjuster’s supervisor |
12th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
147 |
2/8/2021 |
DaisyCollect calls ESIS claims adjuster |
13th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
154 |
2/8/2021 |
DaisyCollect calls adjuster’s supervisor |
14th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
154 |
3/3/2021 |
DaisyCollect calls ESIS claims adjuster |
15th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
177 |
3/3/2021 |
DaisyCollect calls adjuster’s supervisor |
16th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
177 |
3/4/2021 |
Claims adjuster’s supervisor returns DaisyCollect calls |
4th conversation |
Supervisor stated ESIS would send and process $180 payment within one day. Requested an email with payment details once available. |
178 |
4/15/2021 |
DaisyCollect calls adjuster’s supervisor |
17th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
220 |
5/6/2021 |
DaisyCollect calls adjuster’s supervisor |
18th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
241 |
6/16/2021 |
DaisyCollect calls adjuster’s supervisor |
19th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
282 |
8/5/2021 |
DaisyCollect calls adjuster’s supervisor |
20th voicemail |
Left voicemail requesting status of IBR filing fee payment. |
332 |
8/19/2021 |
DaisyCollect calls adjuster’s supervisor |
21st voicemail |
Left voicemail requesting status of IBR filing fee payment. |
346 |
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