Midwest Insurance Fails to Pay QME

Midwest Insurance Fails to Pay QME

If there’s any doubt regarding why California workers’ comp is facing a shortage of Qualified Medical Evaluators (QMEs), look no further than Midwest Insurance. Midwest has been — there’s no other way to say this — dodging daisyCollect since August, when payment to one of our daisyCollect QME clients came due.

After leaving five voice messages regarding an unpaid bill for a Medical-Legal evaluation requested by the Defense, our agents finally reached a Midwest adjuster. But instead of a resolution, the adjuster offered vague assurances of (eventual) payment, sounding less like a well-funded insurance rep and more like an evasive gambler who got in too deep.

On behalf of the client, our agents will continue to devote the time and resources necessary to secure full reimbursement, including penalties and interest. Meanwhile, see the unbelievable conversation below, and consider the mystery of California’s shrinking pool of physician evaluators solved.

Midwest Leaves Best Deal Foods Med-Legal Bill Unpaid

As verified by the law firm of record for the Defendant (the employer, et al), the QME evaluated the injured worker on May 12, 2022. On June 14, 2022, the QME submitted the bill to Midwest Insurance for payment. Per California Labor Code Section 4622, Midwest Insurance was obligated to remit payment on or before August 13, 2022.

But by August 15 (the first working day since the bill came due), Midwest had failed to respond.

The lack of response prompted daisyBill software to automatically generate a ‘No Response’ task, which alerts a designated daisyBill user that a payment is overdue. Since this QME is a daisyCollect client, the task was assigned to our agents to investigate.

A daisyCollect representative called Midwest’s bill review vendor, Rising Medical Solutions, which informed daisyCollect that Rising Medical recommended full payment. The Rising Medical representative instructed daisyCollect to contact the Midwest adjuster directly. On the same day, daisyCollect called the adjuster and left a voice message inquiring about the status of the payment.

Midwest Ducks daisyCollect

The Midwest adjuster ignored our initial voicemail. By September 10, the bill remained unpaid, thereby generating a second automatic ‘No Response’ task. This time, the daisyCollect agent reached out to the adjuster’s supervisor in addition to the adjuster, leaving voicemails for both.

By October, the bill remained unpaid, and Midwest failed to return any calls. The third ‘No Response’ task prompted our agent to get back on the phone, again leaving voicemails for the Midwest adjuster and the adjuster’s supervisor.

Midwest: We’ll Pay When We Pay

In early November, following the umpteenth ‘No Response’ alert from daisyBill software, a daisyCollect agent finally spoke to the Midwest adjuster. The conversation was, to say the least, not worth the (extremely long) wait.

In a testy exchange, the Midwest adjuster informed daisyCollect that payment is pending “reserve approval” and a request for the “additional funds” necessary before Midwest can release “further payments” — as if Midwest had paid at all. As daisyCollect pressed for clarification and reminded Midwest that the bill was months overdue, the adjuster grew increasingly cagey:

daisyCollect: So just for my notes, you said you have a request for additional funds?
Midwest: Correct.
daisyCollect: I'm sorry, can you elaborate on that?
Midwest: Nope that's it. Have a wonderful day.

The full transcript of the conversation is below.

As of this writing, Midwest owes this QME $2,015 for the evaluation, plus $259.10 in penalty and interest payments — and counting. Securing the entire amount due may take several more weeks or months of phone calls and emails (and yes, an Audit complaint was filed).

How can payers bemoan the rising cost of Medical-Legal services and the dearth of willing evaluators, while simultaneously failing to take responsibility for aggravation like this? More importantly, how can California blame physicians for refusing to bear the cost of all this unnecessary, burdensome administrative friction?

Med-Legal billing requires specialized expertise. daisyCollect professionals use our advanced software (and years of experience) to protect your practice. Learn more and request a demo below:


How did you like the article ?

DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.

Thanks for subscribing to daisyNews!