Third-party claims 可以 be challenging for adjusters, 所以我们邀请了克里斯·威廉姆森, senior manager of product management at Mitchell, to explain some solutions to make the process run a little more smoothly.
汤姆 克尔(TK): 克里斯，欢迎来到播客.
克里斯·威廉姆森(CW)谢谢你今天邀请我. I’m excited to share information about bodily injury negotiation service with you today.
TK我们就从这个开始吧. Can you provide an overview of the negotiation services that you use?
CW: 确定. 我们的供应商谈判服务确实是我们多年来与第一方亚博真人官方版APP合作的内容. So, think personal injury protection (PIP) or MedPay, as an addition to our network 调整s for those coverages. 但, 在过去的几年里, we’ve put a focus on adding provider negotiations for bodily injury (BI) claims.
我们可以讨论一些独特的区别，这些区别在人身伤害或汽车责任方面是独特的, 一般责任索赔. 但我们已经建立了一个系统，建立在我们与行业供应商的关系和知识基础上. 和 reaching out to them and securing 调整s on those bills.
传统上，身体伤害索赔的理赔是很难得到的——理赔员确实很难实现这些账单的节省，原因有很多. 我们确实看到了很多人对身体伤害和医疗服务提供者协商的兴趣和增长，所以我们把重点放在了我们的项目上，为身体伤害保险制定一些非常具体的程序. 我们帮你搞定理算员, 通知理算员, 在整个谈判过程中，提供一个开放的沟通渠道，让调整者感觉并控制时机, 因为我们都知道, bodily injury claims tend to unfold differently than a PIP or MedPay, 调整. Giving access to our negotiators is a big part of what we focus on for our bodily injury coverages.
最后, 我们提供该提供商同意的最终亚博真人官方版APP，因此不存在拖欠账单或向受害方或第三方索赔人要求额外款项或额外付款的风险.
In addition to that, we also provide “collateral source“ or prior payment information. 关于 10 percent of the bills that we see end up having a prior payment. 这对理算员来说可能是非常宝贵的信息，即使我们在与特定供应商的谈判中失败. Knowing that a provider accepted a specific amount 可以 make all the difference, especially in those collateral source states like Texas or California. So, 我们真的是为了帮助理算员最大限度地节省未代表的身体伤害索赔，这对理算员来说很难集中精力.
TK: 伟大的, 你提到了第三方汽车索赔面临的一些独特挑战，你能谈谈吗?
CW: 当然,TK. There’s several things that we’ve learned along the way as far as expanding into third‑party coverages. First, we had outstanding base relationships with providers on securing 调整s. 我们发现，医疗服务提供者更愿意也更渴望与我们就这些人身伤害索赔进行谈判，因为支付周期与第一方保险不同. So, those providers aren’t necessarily billing the carrier like they would for a first‑party claim.
所以, 在这些情况下, 了解之前的付款，我们可以将其返回给BI理算员，这确实有助于他们了解他们在每张账单上所欠的真实金额. Where, traditionally, that might be a hard number to get to. 和调节器, in not wanting to escalate the claim or try to negotiate the savings further, 会全额支付吗. 这些理算员没有意识到有机会找到之前的付款，或者由于支付流程不如PIP或MedPay结构化，对于BI理算员来说，很难获得这笔金额. We 可以 integrate with claims systems directly and payment systems for ease‑of‑use.
So, once we establish that payment amount or that agreement with a provider, 我们可以通过亚博真人官方版APP正在使用的索赔系统，在传统的支付流程中触发支付请求，就像我们在第一方或PIP中使用的那样.
我们学到的另一件事是，对于BI调整员来说，与我们的谈判者进行互动和沟通是非常重要的. We have made it much easier to communicate with our negotiations team upfront through a dedicated portal, 以及通过支持线向外伸出援手.
和, initially on their request to negotiate a bill with us, we provide special instructions like remaining policy, 或者在哪里谈判是有意义的, creating a much more collaborative interaction on the BI claim than it may be on a first‑party negotiation.
我要讨论的最后一个挑战是，如果发生这种情况，理算员可能会担心会拖欠账单或提供支持. 我们已经开发了一种方式来提供签署的结算，供应商同意全额和最终支付账单.
All this information is available for adjusters through our support portal, and we 可以 provide those signed agreements on-demand to ensure that the bill is paid, and the claimant won’t see a balance bill for that amount.
So, we secure that and provide support along the way. 再一次。, some of the unique challenges a lot of the processes are very similar to what we do in first‑party, 但有时这个过程有点不同, and we’ve developed procedures in processes and workflows to specifically focus on third‑party claims. It’s a little different because adjusters are going to need a different level of support on those bills.
TK: So, why wouldn't an adjuster just handle these negotiations themselves?
CW: You know that’s something that an adjuster certainly 可以 do, however; it’s very difficult for an adjuster or teams of adjusters to be consistently good at this. 当你想到理算员与律师或直接与受害方合作的核心焦点时, sometimes we’ve found in practice that that gets pushed to the background on their work queue. 这不是他们每天的首要任务, even though there are signifi可以t savings that we 可以 deliver. 调解员不一定有足够的程序或带宽来确保有一个完整和最终签署的和解.
他们不一定总是有专业知识或与特定供应商的付款历史，甚至不知道在供应商的办公室里该联系谁. A lot of the services we provide at Mitchell will make that more efficient. 你可以利用这些丰富的经验和我们与这些供应商之间的关系，真正让调整者把他们的注意力放在他们优先考虑的事情上, which is working directly with the injured party and potentially their attorney to reach settlement.
TK: 和 how successful are these negotiations and how much do they save on average?
CW: So, not every provider will negotiate a settlement with us. 在这些情况下, 如果事先付款, 我们会注意到这一点，并将其返回给理算员，以便他们可以使用该金额来确保准确支付他们所欠的款项.
整体, we have a success rate of around 60 percent of the bills that are sent through us will result in savings. 这样，通过我们的账单就可以节省30%，这是一笔可观的节省，而且理算员很容易把这些账单打包给我们.
We also have customers who have a direct integration and just feed those bills through our solutions, and we give the adjuster a benchmark rate 如果事先付款. 然后, 谈判者会拿着这些账单，与他们进行谈判，以使我们看到的费用总体上节省30%.