I received a press release today that you can read here. Quite nice press release and the website for the firm is excellent. I would like to see a little more meat in the release, but really, if that is my biggest complaint, it is not that big of a deal.
But, then it got me thinking. How many of you understand why insurers outsource things like this? (For the record, most states require an insurance company to maintain a SIU, or Special Investigations Unit, to combat fraud.) Insurance companies outsource SIU, legal bill review, medical bill review and other functions. Ever think about why?
The basic reason is to save money. All businesses that are intent on making a profit will outsource. So, I can’t complain about that. But, and here is where my problem comes in, if you have a claim, the insurance company may refer you to SIU. It may even be your own insurance company. If you are referred to SIU, and SIU is outsourced, they (SIU, not this particular company) may have an incentive to try to prove fraud. Why? Because they have to justify their costs.
And it is not just SIU. If your medical bills are sent out under your med pay coverage, the billing service has to reduce the bills by some amount to justify their cost. That could leave you in a position where you still owe your doctor money, despite having med pay coverage.
Just something to think about. When you hear from an adjuster or an investigator, ask them who their employer is and whether it is your insurance company or an outside company.