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Based on statistics, the TPA and the insurer come to agreement on what the average invoice for all glass only claims (repairs and replacements all jumbled together) should be for a future time period. If the average invoice for said time period exceeds the GAI (guaranteed average invoice), then the TPA reimburses the insurer an agreed upon amount.
This scheme should be illegal, if it isn't, because it gives the TPA a reason to work in concert with the insurer to fix, depress, maintain and/or control prices. Minnesota apparently fined USAA for participating in such an agreement with its TPA. (Guess who?)
In our industry, repair rates have been artificially depressed to those that were being offered more than twenty years ago and today some insurers offer $0 for additional repairs!
The rationale for an insurer to hire a TPA is to save money on the "administration" costs involved in settling claims. Since glass only claims are frequent and menial, (no body damage or injuries) the insurer outsources those claims to an entity that uses less sophisticated personnel that earn lower wages and have less benefits than the insurer personnel. Economies of scale come into play when a TPA can offer their services to more than one insurer.
Insurers can pit one TPA against another to negotiate a lower GAI which results in depressed or lower rates offered to service providers! That's what happened when Allstate left Safelite way back when and went over to Lynx Services and then again when they went back to Safelite. Another example is when The Hartford left Safelite and went to Lynx.
Service providers were suckered into joining networks operated by TPA's. Suckered, I suggest, because TPA's will always be in the insurers pocket and not pro service provider. In reality, if insurers and TPAs were not allowed to sully hard earned reputations of service providers by casting aspersions about them when attempting to illegally steer insureds to favored shops or away from shops that want or need to have a say in how much they can charge for their services, their wouldn't be any networks. Because of this real threat, shops are intimidated and coerced into joining networks.
The TPA's force the network participants to sign unconscionable (one-sided) agreements that require the shop to accept any price offered by the insurer. The insurer, then uses the rates that shops were coerced into accepting to establish what they call prevailing rates.
Public policy regarding conflicts of interest, conspiracies, steering, intimidation, threats, coercion, misrepresentation, deception, price fixing and corruption are being totally ignored by regulators and the companies doing all this are profiting not by competing fairly, but at the expense of their victims.
IMHO Auto insurers have colluded with TPA's, both of which use threats, intimidation and coercion to get glass shops to enroll in networks that require the glass shops to submit to pricing fixed by insurers and enforced by TPA's. The alternative is to have the reputation of their shops called into question by the insurer or its TPA every time one of their customers or prospective customers wants to use their services.
Once the network is established, the insurers use the illegally established rates as the so-called prevailing rate. The insurers even try to limit their liability and the insured's choice of service provider by including unenforceable verbiage in their policies referring to the illegally arrived at prices as the prevailing competitive price!
You can try reachimg out to Farmers agents who do receive a document quarterly. This Document will show the agent slite price the other vendors price used during the quarterly time frame & what the savings could have been. This again should be illegal & beleive it is. A network that also owns retail stores coericing with eachother sharing data to the retail side on what glass companies & for how much did a job for the Insurance company. Hell I wish i had this advantage in my markets to know what competitors are doing,how much.Once again why are you on the network to begin with.The price is horrible, your not a partner they will steal the job.
But let's talk about the real problem.The insurance companies allow the networks to set the pricing for them. Essentially the ins co's hide behind what appeares to be the tpa setting pricing. ANswers sue the Insurance companies one by one.
Sue the networks that collude & manipulate the market. Does anyone know what % of repairs vs replace rate was between s lite & insurance co's.Here is the answer to what they really make on the GAV.
Besides, with the censorship on this site what would there possibly be for insurance companies to troll for? How rediculous. If anyone has hard evidence of how TPA's are using GAI, for pete's sake share it!!!!!!
Public policy from Consent Decrees to laws that give the consumer the absolute right to choose the service provider that works on their car cannot and should not be diminished by an auto insurance contract.
Public policy that bans conflicts of interest should not be taken lightly.
Public policy that bans an auto insurer from ANYTHING that has the effect of steering a consumer to or FROM a specific service provider should be enforced!
Public policy that bans the use of threats, intimidation, coercion and deception must be enforced.
Insurers and TPA's that coerce participation in a network by boycotting service providers that don't participate and by threatening, deceiving and misrepresenting the truth to claimants about service providers that do not participate, must be reprimanded.
Network contracts that require a participating shop to give up the right to set or even negotiate pricing are unconscionable and purported "prevailing rates" derived as a result of such contracts are not valid.
TPA's that enforce illegally determined pricing are just as guilty as the insurance company they represent.
Is anyone on here willing to help? You all sound very knowledgeable about the auto glass industry and I'm hoping someone can steer me in the right direction. Were opening up soon and it sounds like we might have made a mistake joining networks, to be honest I was under the impression that was the ONLY way to bill an insurance company for a auto glass claim. I have only turned in two so far but haven't heard anything back from them yet, how can I get out of my contract with them? Also, how will I bill insurance companies directly without using these tpa's?