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ESIS Fails to Pay IBR Fee on Behalf of ABM Industries

ESIS Fails to Pay IBR Fee on Behalf of ABM Industries

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.

Is ABM Industries Aware of ESIS’ Failure to Pay?

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:

These employers choose to self-insure their workers' compensation liabilities to cover their employees for reasons of cost effectiveness, greater control over their claims programs, and increased safety and loss control management. Self-insurance is an alternative to purchasing a workers’ compensation insurance policy [emphasis added].

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.

ESIS Easily Ignores California Law

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:

  • 3 calls to the ESIS main line for claims
  • 9 calls to ESIS claims adjuster handling the claim in question
  • 17 calls to the ESIS claims adjuster’s supervisor
  • 4 actual conversations with an ESIS representative
  • 1 conversation with the ESIS claims adjuster’s supervisor
  • 0 conversations with the ESIS claims adjuster handling the claim in question
  • 350 days payment is overdue, as of this writing

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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