Is anyone else having fun this week?

We have had continuing "cannot verify" problems with several ins. co. Ironically all of these claims are processed by SGC network.

We have started a new list to track these and confirm our speculations as to when they are happinging, yes there is a pattern forming, and which "type" of customers are being "targeted".

This week almost every Farmers job went to "manual verification", both Hartford claims went to "manual verification". Certain weeks of each month particular ins. co claims are being "manually verified" with no real explanation of why.

Insurance claims managers - Can any of you tell me why SGC, the "leader" in autoglass, is the ONLY network I have these constant hassles with? Why do you continue to pay this TPA when we are the ones doing the "claims processing" by calling the agent, explaining to the insured why YOUR TPA could not "find them" in the system, calm them down after the 10 min call that goes nowhere, etc.

We are looking at charging an additional fee for any further disruptions to our business and that of our customers when we follow YOUR procedures for claims filing, call YOUR TPA to no avail, call the local agent to verify coverage and deductible, and then have to manually bill you (minus the $10.00 fee your TPA charges for manual invoices, even though it was sent manually) because YOUR TPA couldn't do their job.

Not to mention your TPA is now requesting each of my customers email addresses to "send a confirmation email of the claim" (solicitation?), continues to call my customer later that day to inform them they were able to "confirm" coverage while stating "the shop you chose is to busy to perform those services, but one of our technicians is in your area and can be right over if you would like", not knowing we performed the service already.

And why is it ONLY sgc has seems to have these problems or to be polite "challenges". There are many other networks and we rarely if ever, have "manual verifications" (usually only on new vehicles on the policy), rarely have EDI rejections (one of SGC favorite hassles, despite thousands we spend on software, EDI services, pre-audit software), rarely have more than a 3 minute claim call with the insured on the phone, and the other networks are more than happy to let us provide the policy data, thus making the entire experience easier and less confusing for the insured.

And I really do not care that it is SGC persay, I just want any TPA to DO THEIR JOB "efficiently"(as HAL says), not solicit my customers, not tell them I am to busy when they haven't even asked me, and not charge me "manual fees" when it was their fault the invoice was manually submitted. And lets not even get started on the fees now being charged for "paper payment checks".

/RANT OFF

Yes we are having the same type of trouble and it seems to gradually be getting worse. I too have seen a pattern that the claims that go to manual verfication are either steered or attempted to be steered. Some of these jobs are still in "manual verifications" when Safelite shows up and steals the job.

Manual verification is just a name they call their senior level sales people that are professionals at steering. They are not in manual verifications they are just in hardcore steering department at Safelite. I am serious!

I am a "Network Lover" And I will agree with you, the only one this does not happen with is LYNX, now why that is I do not know. However every other network has this problem, Not sure if the other TPA's do not have the INS company data on site or what??? But it does happen with all , OH also never had this happen with Gerber/Globe either.

You rant is totally understood, your not alone brother.


Larry

Yes is a growing problem for me too.
I wonder if SGC shops have the same problem.

Hal

What is your take on this? Lets us hear your honest answer. Remember your have asked questions to us and got your answers.

I've been having the problem with farmers. When it goes to manual verification call their "re-key" department and speak to the adjuster. They'll ask you for the referral number and give you their deductible amount.

I have had this happen all the time with farmers also does not make much sense?

Al - that is exactly my point. Why should we HAVE to call another #? I understand it is our customer and we are taking care of them, but isn't that the job of the TPA, to verify coverage?

All of mine have been Farmer's jobs. I have one from the middle of December I am still waiting on verification. Funny how the agent called the claim in with the insured sitting in his office. Then they called and scheduled the job with us.
I have sent over 10 emails. I have 2 typed pages of documentation of the conversations made on the claim. The agent has involved the main office. We were told to fax it over to Farmers home office. Then we get a letter from SGC saying there is no coverage. I faxed that over to claims as well. Then a mysterious phone call saying there is no coverage. I finally just billed the insured and told them to seek reimbursement. I even gave the insured copies of all the documentation.
It doesn't make us look bad. This makes the Insurance companies look bad.

Now this is when direct billing should come into play, why the heck is farmers so bad, has anyone in a nice tone called SGC (not a peon) and asked whats the deal??

Especially when its agent directed

ccc- your absolutly correct. We shouldn't need to call another #. And if an insurance company is going to use a tpa they should be able to handle it from taking the claim to paying the claim. I was just stating how to handle the manual verification. I wonder if you belong to their network do claims still go into manual verification?

I can honestly say that some accounts are email only. Im sure you all are aware of that, it takes up to a week sometimes to get a response back. It is frustrating for all parties, but being in the insurance business i can tell you that its not just so sgc can come out and get the job or any other glass shop for that matter. Farmers connection seems to always be down, this is something that needs to be addressed towards the insurance companies themselves.

And Al if i may ask what # are you given to the re-key department for farmers? In my experience that is a line that csr's call to get verification from farmers directly.

If you see something a t.p.a. doing that is 'wrong', you should report it to the Glass Manager at the customers Insurance Company. Keep a list of contact people handy.

An insurer's goal is to effectively process claims. It should be a painless and seamless transaction for all parties.

Certainly, there can be times when a 'manual verification' is required--but I would hope that my t.p.a. properly handles these situations. We do have special handling procedures in place for this type situation.

If something isn't working properly--I do want to know about it. I suspect other Glass Managers have the same desire. We all want good customer service.

Here is the contact info for the head of Farmers glass program. This was copied from an e-mail I received from him maybe someone should call him and post his response.

Michael (Mike) Keller
National Claims Manager
Home Office
National Coverage / Glass / Vendor Service department /COE
Location -- KC Help Point
17150 W. 118th Terr., Olathe, KS 66061
Work # 913 826 9007 or 913-826-9115
FAX # 1 913 826 9091
E-Mail -> michael_keller@farmersinsurance.com

GOOD to GREAT!!!!!!!!!!!!

AT FARMERS - SERVICE IS #1 !!!

Al - the simple answer is YES you still get manual verifications when "in network" as well. Sadly we are still operating on a few "contracts".

HAL - You are not like most of your colleagues in my mind. Many do not care or make a million excuses for "unpleasant" or "inefficient" claims handling, not to mention timely payment issues.

I have always felt that you sir, care as much as you are allowed by your bosses to care. But many do not, many simply turn it all over to SGC, accept their "advice" (pricing, etc.), and read the monthly, quarterly, and annual reports SGC generates to them, never truly digging and verifying the data despite policyholder complaints (that would mean they actually have to work you know ).

It does happen; we have seen it and do talk and deal with these managers often. Some simply do not care or think we are just a whiny competitor all the while missing the point that it is THEIR customers who are most upset and confused when SGC cannot verify coverage, which if I am correct, IS THEIR JOB is it not HAL?

I realize "manual verifications" do happen and need to happen in some cases, such as a new vehicle on policy, payment gaps, etc. But HAL your TPA has had to manually verify over 75% of the claims we called into them over the last 3 weeks for 4 ins. co. they process for. THAT CANNOT be "efficient". The companies were notified by us, and some policyholders called the company as well.

My point is, if SGC is the biggest, best and the industry leader as they claim to be, then why are they the WORST at claims processing on this end of the calls?

If I can type in a zip code and have a drop down showing the cities it applies to, why can't your TPA? Which they cannot as the SGC csr always has me spell out the city name and explained they do not have that capability. No wonder SGC has so many EDI rejections, to much manual data entry that is not needed.

Why can I call a local agent or regional office and in 30 seconds have the coverage verified, but it takes SGC at least 3 hours to 3 days to verify the coverage and "approve" the needed services?

Why can’t I charge you HAL for verifying the coverage when your TPA cannot (not counting needed manual verifications as stated above), and when it is my verification that then allows the insured to have the needed repairs performed in a timely manner and not be confused and stressed thinking they do not have insurance coverage?

The only thing on this side of the claims call that is good about SGC network is that they are NOT GERBER. And thankfully so

ccc

Hal will get back with you soon, I'am sure his TPA will have the answers you need....is 3 days too long?

Sometimes the link between the t.p.a. and client's computers can be interrpted. When this happens, the t.p.a. must do a manual confirmation.

Also, some commercial auto policies can create coverage confirmation problems when there is 'blanket' coverage and specific vehicles are not listed.

I appreciate your offer to confirm coverage, but that wouldn't work for our type operation. We must limit access to our records.

HAL - we confirm coverage all the time what are you talking about? Perhaps your company does not have local agents? Some ins. co. will only give the policyholder the policy number but that is easy enough and understandable.

HAL, I know you get some answers from Safelite, and some are your own, but the reasons you stated above are well known and are NOT what we are talking about.

We do get "manual verifications" for legitimate reasons and we know before placing any TPA calls that these can occur as mentioned earlier, commercial policies, new vehicles, for example.

But when a TPA "manually verifies" over 75% of all claims calls for 3 weeks straight, from policyholders and vehicles we have processed before, then SOMETHING is going on. And the network was not down for 3 weeks; otherwise we could not have processed the other 25%.

HAL, I understand you are happy with SGC, and they help you meet your program "goals". And I am not here to complain about SGC or your company.

The complaint is that we are forced to use SGC, the one TPA that makes it the most difficult for the INSURED. They will not take a claim (partial or in full) from the shop, or the agent (most cases), and make it increasing more difficult on the insured by asking more and more questions that are not needed.

Asking a policyholder for his email address? What legal reason is there for that question? Birth dates? Asking a policyholder if he/she is self-employed? What time the damage happened? Arguing, yes arguing, that a rock chip MUST have happened in a city, even when the insured insists it happened on the interstate.

There are no laws requiring these questions HAL, you know that.

You have already admitted on this board that you ALLOW SGC to TAKE every job where an insured does not have a preference of shop. So what keeps SGC from doing everything they can to dissuade the policyholder from making a choice, either by using "manual verifications" to delay that choice, or using now famous wording like "that shop is not on our network"(which is simply code for "HAL will have to pay more if you choose that shop".)

As I have mentioned many times HAL, we do not do work for your insured, and perhaps YOUR program is run differently and more fairly than most.

Once again, I do want to thank you for your participation on this message board HAL. Hopefully over time we will all learn from each other and the dialogs that have and will continue to take place.

Hal

You never answer a question on this board without offening the inteligence of our trade. WHY?

So try to answer this question in a polite non-offending manner:

What do you call it when your TPA our competitor reccomends pricing to you that effects pricing not only on a local level, but on a national level also.

This board has been telling you since you joined our dicussion costs have gone up and you have the nerve to try and lower our sundry pricing.

What does it take for your industry to believe us?

I am a customer service rep at Safelite Solutions and process insurance claims for several insurance companies. I just found this forum and have no intention of getting into the "politics" involved between companies, but may be able to shed some light as to how these claims are processed.

I'm responding to CCC since that was the last post.

"But when a TPA "manually verifies" over 75% of all claims calls for 3 weeks straight, from policyholders and vehicles we have processed before, then SOMETHING is going on. And the network was not down for 3 weeks; otherwise we could not have processed the other 25%."

Which insurance account?

"They will not take a claim (partial or in full) from the shop, or the agent (most cases), and make it increasing more difficult on the insured by asking more and more questions that are not needed."

It depends on the insurance company. The majority have restrictions on who can call in the claim but they are not all like that. All questions asked are from a script approved or given to us by each insurance company. There are basic questions asked for each, but some have additional questions which we are required to ask as instructed by each insurance company.

"Asking a policyholder for his email address? What legal reason is there for that question? Birth dates? Asking a policyholder if he/she is self-employed? What time the damage happened?"

The email address is an alternate means of providing the insured with their claim info (referral #, callback #, etc.). I would get regular requests to email this info before we had this option, there's no legal reason for it beyond being in the 21st century (age of the computer) and providing something that the vast majority of callers like.

Birth date questions confirms the callers identity as the policyholder. It's sometimes funny how obvious some shop employees are when they call and pretend to be the insured. Never heard of the self employed question. Time of loss is only asked if the insurance company has us ask it. But to be fair, many insurance companies ask that same question when someone reports an accident claim so it's not an out of the ordinary question.

"There are no laws requiring these questions HAL, you know that."

You're right, no laws for asking it but some of these questions try to cut down on insurance fraud which is a big problem in any part of insurance claims. I've seen it first hand. Yes, insurance fraud happens in the glass industry and it's probably more common than most think.

I've seen countless claims where the shop rep tried to pull some shady tricks, the majority don't but there are always those few that ruin it for everyone else. One shop would send a mobile tech out into neighborhoods and look for broken windshields to repair (no big deal). They would offer a deal to the insured to report several repairs when there would only be one (sometimes no damage at all) and they would give the insured money to do so (a big deal and illegal).

Rep, I appreciate your post and thanks for your contribution, but please don't use the fraud scenario.

Insurers do not have the right to declare martial law on an entire industry not their own. Further, I would ask how many times those people that are trying to commit fraud are actually reported to the authorities for it.

Taxpayers pay for the DOI fraud units in most states. That means insurers have the legal means to stop fraud and they don't even have to pay to investigate or report it past some phone calls.

I have seen and documented many instances of insurer fraud, seen large glass companies openly admit committing fraud daily, yet, neither are ever prosecuted.

I'm sorry, but 'fraud' is at least in part, an excuse for networks to justify themselves, and it just isn't within your jurisdiction.

JMHNLO

It depends who the csr is and if they realize something fishy is happening, and secondly if they even care. Personally, if I ever have a suspicion of something being wrong I will either immediately get one of our supervisors and/or call the insurance company to have them look into it. It really irritates me so I will go the extra mile to alert someone that the call in question needs to be looked at in more depth.

However, the call centers employ alot of people and I'm the first to admit that some of the csr's that work there aren't the brightest and I personally wouldn't want to get them if I was reporting a claim.

First of all I want to say that bad mouthing Safelite is a very unprofessional way to get your issue resolved. Secondly I have been with them for over 9 years and we are not STEERING. We have a script that we must read that is approved by the insurance companies.. As far as pricing goes that is a set price by the ins co that is written within our contract.. And as far as the unable to verify claims I will use Hartford as an example.. if the rep you get doesnt have a connection(no id for HArtford) then yes it will need to be verified manually.. and it is an email account only.. We cannot speed up the process. Also addressing the issue of where we collect an email address from the customer now is yes to send them a confirmation.. No one is calling the cust back to tell them they cant use your shop.We do not steer. so dont go hating on Safelite because you cant capture the job..Any more questions???

Safelite Rep

Its not to late to seek profesional help. Your condition of denial can be helped. There are thousands of indepedents that can prove you wrong!

AMEN, THT.

Rep, I respect your opinion, but have to say, that we tape calls too.

I'm glad that you don't do some of the things spoken of, and respect you for that.

Unfortunately, you cannot speak for others. And, oh most definitely, customers are getting a second 'call back'.

Perhaps it's happening at a different level than what you see daily? I have several that come to mind that the customer gets a second call from a different person.

Safelite call center rep...

Based upon your acute sense of "something fishy" going on... it's a shame that we didn't have you in charge of looking for WOMD. Heck, you could have went to a supervisor and notified them right away.

What an obvious waste of talent.




Jan 20th, 2007 - 3:48 PM Re: Networks "unable to verify"

It depends who the csr is and if they realize something fishy is happening, and secondly if they even care. Personally, if I ever have a suspicion of something being wrong I will either immediately get one of our supervisors and/or call the insurance company to have them look into it. It really irritates me so I will go the extra mile to alert someone that the call in question needs to be looked at in more depth.

However, the call centers employ alot of people and I'm the first to admit that some of the csr's that work there aren't the brightest and I personally wouldn't want to get them if I was reporting a claim.

SGC Rep,
PLEASE! Try to convince someone who hasn't been there that SG doesn't steer!! There are too many shop owners and CSR's on this forum that deal with it on a daily basis, myself included. So, again, please tell that to someone who might believe it. We do not!

Yes, SGC rep, I have a question.

In another post about urethane HAL (form the dark side) stated “My TPA (SGC) company is telling to pay less for urethane."

Which one is it HAL and SGC, which one of you are dictating price to the industry? I know this is the type of question that you don't like to answerHAL. But don't you think it’s about time that we get an honest answer?

For the question regarding the urethane. I simply cannot answer that. I am not in the billing dept. I can only answer the questions in regards to the issues that you seem to be having within the network.
As far as steering goes.. We are not trained to steer nor should any csr do that. Our conversations are recorded as well so if you have an issue with that then you need to call into the network and have it addressed. I know 1st hand that the calls will be pulled and the issue will be resolved. We all get the same training and I can assure you that settering is not part of the training. Safelite is really a great company and I think that as a whole in the glass industry everyone can be satisfied but, if you do not make someone aware of your problem then it cannot be fixed.

Safe Lite????

Yes, SGC rep, I have a question.

In another post about urethane HAL (form the dark side) stated “My TPA (SGC) company is telling to pay less for urethane."

Which one is it HAL and SGC, which one of you are dictating price to the industry? I know this is the type of question that you don't like to answerHAL. But don't you think it’s about time that we get an honest answer?

Some very good dialog! Thanks to our new contributors for their informative posts. While we insurers or tpa's cannot always give you the answer you want--at least you will have some insight to what is driving the 'other side'. I am convinced that dialog can help resolve some nagging issues, while we learn from each other.

I am sure that you have a policy to verify coverage to protect yourself. We also have to verify coverage to protect ourselves. Perhaps a duplication--but we must conduct this coverage confirmaton oursselves.

Best wishes-

Many people have said steer clear of the Networks! Which I would agree with,(We Are Not On SGC Network nor will we ever be)But I just had a SGC fax for a Progressive Insured, Rates As Follows: 49%off Nags List,I told them I would call Progressive,I did just that,Only to be told the only way the Insured could use our Shop was if we would ONLY bill through SGC,Or the Insured could pay us and then Submit the Paid invoice to Progessive for payment.So would anyone like to address this????????????????????????????????????????????????????????????????????????????????????????????????????????

If insured did choose to pay us 1st and collect later from Progressive,then Insured must talk with Progressive 1st.............Hmmmmmmmmmmmm,wonder why..........(Scare Tactics)

Where are all the KNOW IT ALLs????

Great non answer! I hope everyone takes that into consideration the next time we get a discount increase from our competitor SGC.

SGC I know you record the conversations and I also know first hand that you will not let us hear them either. I had a steering incident with the Hartford and was not granted access to the conversation. Yes, The Hartford admitted that the SGC csr was a "little to aggressive". But SGC or the Hartford never let me get a hold of the tape. So what is your point of telling us this SGC is it for legal purposes?

WAKE UP PEOPLE, BIG OR SMALL WE ARE ALL IN THIS TOGETHER. IF YOU WANT FIX THIS WE MUST STOP THINKING OF EACH OTHER AS THE ENEMY!

Glass guy look at my Prgressive copay post.. It really works try it

Thanks SB,I have read your copay Idea and I must say I like it very much,However im just not sure about the legal aspects of such an idea.

Anybody heard the latest on S-lites plans to move their call center to Samoa?
(What a great company)!

This is for Glass Guy-In regards to the Progressive.. they handle their own claims and have for quite a few months now. Safelite doesnt take their calls. when you call in a glass claim you are talking to a Progressive Paid rep not SGC

If that is the case how come the most recent pricing update for Progressive that was dated 1/10/07 came from the SGC Network?

It is always suprising how many people can go to work each day and be led around like a bunch of puppets and defend to the death a company that does things like Safelite.

I will say that I belive there are some at Safelite that really have no idea what REALLY goes on but after taking several calls from upset people for the same issues I think one has to pull their head out of the ground and start asking questions.

This Is For The SAFELITE REP: Apparently you do not know as much about your Employer as most of us do,Safelite Does in fact do the Billing for Progressive,I am looking at a referral for a Progressive Insured, direct from SGC = (Safelite Glass Corp.) In case your not aware of this either.
I have 20 years in this Industry,I know when im talking ****lite........

For Glass Guy-I never said that we didnt handle the billing we dont handle taking their claims.. REREAD my earlier post.. And I am well aware of what I do I have been w/sgc for many years and I guess since ur not on my end then u just dont understand.. there are different situations that occur and I am just stating what we are supposed to do at the network.. I am not claiming that everyone does it right

Hello I'm a Safelite Rep.Please hold the line while I fetch my SCRIPT..........Because the current conversation cannot continue,I would prefer to know what I am talking about...........Ooops I mean my company.....No wait I mean me??? Oh darn being A SAFELITE rep sure does take alot of careful wording........

Why are any of you even calling into Safelite to verify coverage or report the claim? Once you do that it generates a referal number and a fax to you. The fax reads "performance of work constitutes acceptance of pricing." The insured's contract is with the insurance company not Safelite. We call the agent or insurance company on every job we do and bill the insurance company direct. Although most invoies end up in Safelites hands anyways, at least we are not giving into steering and acceptance of pricing. Why is anyone calling Safelite? All that does is have the job steered away.

SGC REP- have you ever worked for another glass shop? Things have changed drastically in the past 9+ years. Cost have increased while claims payments have decreased. Your so called Great Company you work for HAS had a major contribution to the eroding prices in our indrustry.
I wish you would go work for another company and see it from our angle. You need to try calling in these claims with the insureds. Try to service the insured within the time frame they must have while still waiting for "verification" to be done in a timely fashion.
Or maybe you need a promotion to a different department before you speak of what you do not know. There are many higher ups in your company that play dirty. Must of us in this forum know this all to well. I hate to admit it but I was a CSR at one point in time due to a merger (not my choice!!!). I could only hang with them for about 8 months. Best move I could have made for myself was to walk out that door and watch them bleed. That shop closed up within a few months. All of the employees walked out. You are just a number and they only care about units.
What is your job title? After nine years, You should be the supervisor!!
Word of advise: Don't tell your boss you are talking on here

TM - Some of us on this forum are NOT OWNERS and still have to process through SGC, or networks in general, because that is the policy of the companies we work for.

This may answer your question in part as to why some are still calling SGC or any network.

Okay, I just have to put my 2 cents in here. I had a customer that called me yesterday because her windshield was broken. We have already done 3 vehicles for her and she likes our work. Her car was vandalized and she was trying to get the kids that did the damage to pay for the replacment. That wasn't happening so she called the number on the back of her insurance card and got SG network. They told her that there were only 2 shops in her area and she HAD to use one of those. She told them that she wanted to use us and they told her that she couldn't because we are not on their network and her insurance wouldn't pay for us to do the work. They very kindly called and scheduled an appointment for her with SG and she has to take it to their shop. Once again folks, THERE IS NO SUCH THING AS STEERING!!!!!

We've also noticed an increase lately in those, that state that the insured may NOT use the shop of their choice, seemingly under any conditions. This differs from the 'you can go there, but you'll have to pay the difference' speech/script.

Fortunately for us, we have a strong consumer pre-loss education program in place, to combat this, but still we have revived some older advertising surrounding the 'right to choose' state laws we have.

Just goes to show, anything is legal as long as one can get away with it.

Thank goodness steering isn't actually happening, as was said, or this job would be much tougher. lol lol

In 'defense' of SGC, it's not just them. THey all do it. And I mean ALL. To date I know of no network that does not employ some kind of steering tactics. In fact, looking at our documentation database, SGC has been one of the more mild ones.

JMHNLO, (but with tapes to back it up...lol)