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Hypothetically: SGC schedules a repair order for your customer at $45. That day the SGC tech goes out and determines that the glass in NOT repairable and needs a replacement windshield. The repair work order remains on the systems but the price is adjusted to show a zero sum. The next day SGC writes up a second replacement work order for $300 to your company and goes up and replaces the glass. At the end of the month your average unit cost for a windshield from SGC is $150.00 (2 work orders divided by $300= $150.)
The following day a TPA contacts an independent to repair a glass. The independent goes out to the vehicle and discovers it is not repairable or we repair it and the customer does not like it. The follow day the TPA calls the independent back and tells us we are obligated to replace the glass and give that repair to you for free. We don’t know if the TPA deletes the first bill to you but, we do know that there is no consideration given to the independent for fuel costs, labor, wear and tear or the products used. We are only expected to wrap that into an unreasonable discount and pay a brokers fee to the networks in order to recoup some of our costs.
Unfortunately, if you own a network and have a contract with a large insurance company based on average unit pricing it is in your best interests to practice this double jeopardy.
Hal, my question is do you consider this practice insurance fraud and what is your opinion on this double standard? Do you think this type of standard will breed further fraud if it continues to happen?
sb-
I am not sure I really understand your question, but will try to respond.
In your 1st paragraph, we would record it as one $300.00 loss.
In your 2nd paragraph, there are a few variables which make a definitive policy statement difficult.
If the repairs are not accepted, we usually would pay our TPA for the replacement only.
In your 3rd paragraph, you appear to be making a statment about a business model we don't use.
In your 4th paragraph, IMHO it would be fraud if the TPA billed the insurance company for both repair and replacement when they didn't pay for the repair and replacement.
Do you understand the scerenio in the first paragraph that he is presenting?
Since SGC oftens uses the average cost per claim to sell their program, are you able to tell me that they do not use this type of procedure to make the average cost appear better?
In other words I understand that it is one claim as it should be under current guidelines, but when SGC is trying to keep the average claim cost at $196.00 per job for an example, so they iniate two seperate REFERRALS and one has a $0.00 amount which really helps keep the average down. Then they use these numbers to distort the "average" when selling their program.
Thank you SBOK, Hal, how about your opinion on SBOK'clarification between the TPA's ability to use a non repairable glass as an illusion to make insurance companies think they are recieving a lower cost. And the non TPA shops having to consume all the costs related to going out and atempting to satisfy your customer?
WHAT ABOUT THE TPA'S MAKING YOU GET APPROVAL TO INSTALL A DW1459GBYCAR ((03 FORD FOCUS ,CARLITE W/S).
THIS IS THE PART THAT CAME OUT OF THIS CAR AND THEY TELL ME I MUST SHOW PROOF OF PURCHASE W/ OUR COST CLEARLY LISTED.THE TPA SAYS THE REASON IS THAT THE INSURANCE COMPANIES WILL NOT PAY FOR DEALER GLASS UNLESS WE CALLED TO GET APPROVAL AND HAVE AN APPROVAL # .
THE CARLITE W/S AND AN AFTER MARKET W/S HAVE THE SAME LIST PRICE (237.10) AND THE CARLITE COST ME LESS THAN A PPG . SO I DON'T UNDERSTAND WHY THEY OUR GIVING US PROBLEMS .
THIS ONLY HAPPENS WHEN WE DEAL WITH ALLSSSNAKE. IS THIS FRAUD OR JUST A WAY TO TRY AND GET SAFE FLITE TO DO THE JOB WITH A $40 W/S
I don't see Safelite playing games with my numbers as you suggest. We also have our own management reporting system with verifies this is not an issue with my program.
It is becoming obvious to me that there is a massive conspiracy to make TPA's look bad. It is taking place not only on internet posting boards, but also in bars, night clubs, pubs, public events, doctor's offices, wharehouses, baseball games, high school events, social gatherings of many kinds, trade shows, conventions, and generally anywhere at least two people in the glass profession may meet.
Knock it off, kids, Hal would tell us if anything we have to say is within the boundaries his company has set as fair and reasonable statements, as has been determined by his surveys, and decisions to be more, or less, agressive with those results and applications of them in their business model.
Mark and Hal why don’t you release those surveys to the world and put an end the so-called conspiracy? Or maybe it's time for the independents to band together and start testing our waters? That is not a hint IB!
Well, how about that Hal? SB has brought up that same old question about the surveys.
Think it's time to show what the market surveys revealed, and how (by your own words) you are more, or less, aggressive with the pricing as you decide?
Surely market surveys obtained from pricing in the public, by the public, for the public, aren't proprietary information, are they?
I would certainly understand why you wouldn't want to release how your company is 'more or less aggressive' with the actual pricing you recieve from those surveys, after all, it basically defeats the purpose of them in the first place if you manipulate the results after you get them.
I'd also like to hear if those surveys account for quality of glass, materials, and installers, as case law dictates.
Oh, and SB, someone besides the insurers and networks IS building a database of a 'REAL' market survey, based on actual invoices, not faxes and funny paper by people not even in the contract of repair with the consumer.
here is the game Safelite and even Harmon do, they say you can repair of 6 inch crack, How many people to you think really is satisfied with that. NONE, Safelite tells cusomter it can be done but oh by the way, I have a w/s just in case, one trip, they show they did the repair, but they replaced, report all the repairs as repairs on their report, but never shows how many repairs are replaced because customer does not like it. but their report shows they did all those repairs.
Hal, we know you live in the same world as safelite, and I think you know the game
I haven't seen any figures for the number of repair efforst that were insatisfactory and resulted in an untimate W/S replacement, but will inquire. I would think you and the TPA would make every effort to screen out those w/s that are not a candidate for repairs--let's do it right the first time!
In an 04 interview Dan Harris said his repair #'s grow by double digets every quarter ,i guess the previous post explains all about that . I talked to my Dad (ex Safelite manager) and he said that his guys always took w/s with on a repairs and this was in the mid to late 80,s he also said that if the FBI was to investigate Safelite they would be in some serious s**** because of practices that they still continue to this day . He also said the insurance industry will never do a thing about it because safelite saves them so much money every year.
yep, safelite saves them money, and gives them a kick back at the end for all the work that they did. as far as not likeing the repair lets do it right the first time, ok Hal, you put in a claim for a repair tell them its the size of a dime and in the middle of the windshild out of line of vision, but it bothers you. too bad you will get only a repair! I have one and you know I think its a state auto, if it is I am calling you Hal, but the customer told safelite where it was and the size, size of a dime middle of w/s but it bothers them when they drive because they know its there. They want it replaced, well Hal I have been fighting with safelite to correct it from a repair to replace, and it needed tobe replaced, it was small but smached to the point you could not fix it. I cant get the "oh so wonderful" safelite to get it in their heads that it could not be repired I need the dispatch /# changed from repair to replace, they keep sending it as a repair, and paid only a "repair" I keep saying come audit my books let me show you safelite.
"I haven't seen any figures for the number of repair efforst that were insatisfactory and resulted in an untimate W/S replacement, but will inquire. I would think you and the TPA would make every effort to screen out those w/s that are not a candidate for repairs--let's do it right the first time!"
So I believe that you understand that question I ask much earlier in this thread and it appears that you will inquire. That is all I ask.
I hope that they "do it right the first time!", but I am concerned that with the pressures from LYNX, Independents, etc, that they may be using "creative" measures and math to make things such as chip repair numbers appear more favorable than they are.
Safelite does not take out a windhsield "just in case" anymore. In fact any replacment company that does not have a separate windhsield repair division has that ability including any independent. Their repair Medics division is a sound practice. They pay less wages and overhead for these employees and have a greater chance of getting repairs to be successful. They actually make money on that side of the company where most of us fail when it comes to repairs.
The quesstions you do have to ask the TPA or Insurance company is:
1)If SGC went out to do a repair and it ultimately was not accepted by the customer, would SGC Credit/ rebill the origional invoice making it zero cost to the insurance company and adding a replacement on this same invoice or would they simply credit the cost of the repair on a new work order with the replacment? If the latter, their reporting system would show a 50% repair ratio for this "same claim" verse an actual zero percent repair ratio in which it truly is. They have one invoice for a "completed" repair and they have a second invoice for a windshield that is actully $50-60 less than what it should be due to the repair credit. This would actualy also show their invoice average being less than what it really is.
2) Has SGC ever offered and/or been accpeted by State Auto for a "savings guarantee". Meaning SGC may guarantee a certain savings either by repairs or low replacement costs to State Auto for contractual period usually annually. If at the end of the quarter, semi annual or year, SGC does not meet this savings guarantee then they credit or write Sate Auto a check for the difference?
3) Does or has Safelite every shared their confidential reports on competing glass companies doing work for the insurance companies via their network to their sales force? Has SGC Sales Managers ever contacted managers such as Hal knowing this info and more than likely refering to it to "promote the program"?
Is it fraud if a car comes in with Tinted windshield. You put in the Shaded windshield. A better glass for the customer. But the tinted glass cost more. You are supposed to put back and charge for the glass that was in the car. If the car had Tinted and we put in a more expensive Shaded, years ago we were obligated to charge Tint price & collect difference from customr.
Hal if kickbacks are not an issue how can some co. say on TV they will waive or pay your deductible?This is on NC stations,with new NAGS their is no way the ins co.is not paying what is waived.Lets face it the ins. co. thinks they can run the Glass Co.If figures were shown,we would prove that small shops do better and we have less call backs.We take pride in our reputation.