COLLECTION PROCESS IN A NUTSHELL
What We Do in a Nutshell
Since 1998 our law firm has helped roughly 1,000 hospitals, diagnostic centers, physician practices,
and emergency rescue providers collect over $25 million in unpaid and underpaid insurance receivables – in most
cases with no fee to the client and no percentage of the
How does the process work?
In short, our office has an attorney review each of
your P.I.P. files (one by one) going back 5 YEARS to
determine if you were underpaid or wrongly denied by the
P.I.P. insurer. We do the work for you reviewing each
and every auto account receivable to confirm proper
payment. Files remain right in your office and any
claims we identify as payable we digitally scan with
portable equipment that we bring. From those scanned
files we create a list for your review and approval to
pursue for collection.
What happens once files are approved to pursue?
The process is simple. We first send a written
demand letter to the insurer notifying them of the claim
dispute and advising them that they have 30 days to pay
the claim (along with the applicable interest and
penalties) or a lawsuit will be filed. If the insurer
chooses to promptly resolve the demand (currently
approximately 80%-90% of our claims resolve pre-suit)
then the insurer pays no attorney’s fees and costs – it
is only responsible for payment of the payment of the
medical benefits plus postage, interest and a small
penalty of 10% of the overdue amount (Our payment is the
penalty and interest only).
So take, for example, a $1,000.00 claim that is 1 year
overdue – here is how the settlement would break down:
1) $1,000.00 paid to the medical provider – we take
no cut of the recovery!!!
2) $100 penalty (10% penalty paid by insurer in addition
to what they owe you) – paid to us as attorney’s fees.
3) $47.50 interest (4.75% statutory interest paid by insurer
in addition to what they owe you) – paid to us as
attorney’s fees. Insurer must also reimburse our postage
TOTAL ON THIS $1000.00 CLAIM EXAMPLE = $1000 to you.
$147.50 to us.
What Happens If They Don’t Pay Your Demand?
Florida law provides stiff penalties for insurers
who do not timely pay claims. Specifically, an insurer
may be liable for payment of the consumer or medical
provider’s attorney’s fees and costs if a suit is filed
and even a nickel is recovered. So taking our example
above, if the insurer refuses to pay the $1,000 demand
and suit is filed the insurer will be liable for the
$1,000 plus interest plus attorney’s fees and costs if
it loses. Attorney’s fees and costs generally start at
$2500 and reach $400 per hour or more if they continue
to fight. So, there is a strong incentive for the
insurer to resolve the claim for the $1,147.50 demanded
($1,000 plus $147.50 penalty + interest) rather than risk
paying thousands (even tens of thousands) more if it was
wrong. The key is case selection – which is why we pride
ourselves as being the only firm we have encountered
with 2 dedicated intake attorneys reviewing new files to
determine if they are proper cases.
We have lawyers and collection people -- aren’t they
The short answer is – most likely – NO. Most
facilities use the following flawed collection process:
1) Bill the primary insurance (P.I.P.);
2) If P.I.P. doesn’t pay bill the secondary insurance;
3) If the secondary insurance doesn’t pay – after 90
days send it to a collection company who takes a hefty
cut of the recovery.
What’s the flaw?
In short, you’re ignoring the two deep pockets (PIP and
health insurance) to pursue the patient who likely has
no money or, if he does, is rightly saying “I have 2
insurances – GO AFTER THEM!”
How Do We Fix It?
1) Change your thought process by fully pursuing P.I.P.
(Don’t accept that denials and reductions are right).
2) Once you have fully pursued P.I.P. that opens
collections to your secondary insurer.
3) Complete payment from P.I.P. and the secondary
insurance then leaves a smaller co-payment and
deductible balance, which is easier for the collection
staff or collection company to recover.
What about HIPAA?
Our firm utilizes HIPAA independent contractor
agreements and works as an arm of your collection people
– maintaining full compliance with all requirements of
the Federal HIPAA law. Remember, HIPAA does not bar you
from collecting your balances.
Some of Our Representative Clients Include Nationally-Known Health Providers Like:
Bayfront Medical Center; Baycare Health Systems, Mount Sinai Hospital; Memorial Health System; A-1 Medical Imaging; CORA Physical Therapy; Tower Imaging; South Florida Baptist Hospital, and the list goes on . . .