Automobile no-fault claims that pass across an adjuster’s desk contain a myriad of injuries and a wide variety of treatment options and recommendations. Not uncommon among many no-fault claims is the use of prescription drugs to treat injured claimants. The involvement of prescriptions necessitates that adjusters must work with not only the injured claimants but that they also work with pharmacy services providers in order to properly indemnify the claimants.
An additional challenge with these types of claims is the fact that as many as 50 million of the four billion prescriptions filled each year in the United States may be inaccurate, according to NBC New York’s investigative study. While this number is staggering, it is more or less an educated estimate. Currently, there are no laws in place that require errors on prescription drugs to be disclosed. Together with the challenge of assuring auto-relatedness of prescriptions, these errors are a major concern for insurance carriers facing steadily rising costs of auto no-fault claims.
Many insurance companies typically have some type of system in place that allows for a review of prescribed medicines for their no-fault claimants. However, there are oftentimes flaws or missing checks and balances within those systems that inadvertently lead to non-injury-related claimant prescriptions being approved and paid for by the insurance company. One common situation that occurs involves a claimant with a pre-existing condition or illness that requires them to use prescription drugs for treatment. Claimants are typically unfamiliar with the intricacies of claims processes and may unknowingly submit their auto-related prescription together with the non-auto-related prescription to the insurance company for payment. One important step that must be taken by the insurance company to avoid this type of situation involves the implementation of a proactive versus reactive approach.
Northwood has proven that a proactive approach to assuring injury relatedness of prescriptions saves both time and money for the insurance companies it partners with. As a third-party administrator (TPA) of auto no-fault claims, Northwood acts as a Pharmacy Benefit Manager (PBM) for insurance companies to implement a pre-authorization system for all prescriptions. This approach ensures that each prescription submitted for payment within a no-fault claim is injury related which eliminates unnecessary costs for the insurance company. Northwood is an experienced PBM and partners with numerous insurance companies in Michigan to implement these proven procedures within their no-fault claims administration.
Furthermore, when claimants choose a pharmacy services provider within Northwood’s expansive network there is no out-of-pocket cost to claimants for their filled prescriptions. Additionally, each provider participates in a rigorous credentialing process to ensure the highest level of quality is offered to each claimant and to provide the lowest cost to both claimants and insurance companies. This extensive network and the elimination of cost to claimants combine to provide savings along with significantly increased claimant satisfaction levels.
For more information about avoiding prescription errors commonly associated with automobile no-fault claims please contact Rosanne Brugnoni at 586-755-3830 ext. 3771 at your convenience.
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