Table of Contents
When margins are already tight, being approved for partial payments by insurance can be frustrating.
The upside is you have the option to appeal partial payments, and even better: insurance companies follow a consistent pattern. You just must learn what they’re looking for and your job will become much easier.
This guide walks you through how to appeal partial payments, providing resources to help you get your full reimbursement. You’ll also learn how to avoid this mishap in the future.
Why claims get partially paid
Insurance follows procedure. Despite industry-wide confusion in dealing with these agencies, it’s important to note that their formula is straightforward: what is submitted versus what insurers expect to see as evidence.
Once the necessary facts and evidence is provided, then reimbursement is easy.
Common causes of partial payout include:
- Lack of documentation: Many agencies require OEM documentation that proves the complexity and importance of certain ADAS work. You also may lack evidence for each step of the process.
- Policy lag: OEMs move quicker than insurance policies, agencies may not account for the latest ADAS needs and require express-written proof of necessity.
- Pricing discrepancy: Agencies may have mismatched or outdated info on industry rates for labor, parts, and research fees.
Remember that insurers are not on the shop floor with you. They are not constantly fighting to stay on top of the quickly-changing aftermarket like you and therefore, decisions are driven by what’s documented.
You can meet them where they’re at by providing this documentation.
What you can do to appeal partial payments
When you face a partial payment, you do not have to accept it right away. You carry the burden of proof when it comes to all the necessary evidence. If claims are repeatedly denied, then hiring a 3rd party public adjuster is also an option.
Before accepting what was sent to you, you should first understand how appeals work.
Review the EOB
The Explanation of Benefits (EOB) details how a claim for vehicle repairs has been processed, including what is covered and what the shop/vehicle owner is responsible for paying out-of-pocket.
It includes line-item discrepancies, denial or reduction codes, and missing justification flags. You want to verify the accuracy of this document so you know exactly what was not covered and why.
Submit an appeal for a second review
After reviewing the EOB, send a formal request for an appeal within the stated timeframe. Expect to be asked to provide extensive documentation.
Gather all necessary documents
Here, you don’t want to leave a single stone unturned. Remember, nothing is implied and everything needs to be explicit and verifiable.
Include:
- Pre- and post-calibration scans with photo evidence
- Documentation of environmental set up
- Step-by-step calibration process with photo evidence
- Verification of successful calibration
- Current OEM guidelines that validate the need for your work
- Identification of the tech(s) who performed the service, their certification, and the time duration of the work
- Pricing justification via peer comparisons or estimating platforms
Format your appeal correctly
Format and organization is important and you want to use the correct coding and modifiers. In the appeal documents they send, you can mirror their language found in the EOB.
Include your claim number, a clear statement of disagreement, and a point-by-point rebuttal of their decision, supporting evidence tied to each point.
Preventing future partial payments
Appeals solve an immediate issue, but documentation prevents the next one.
Creating a standardized ADAS claims package is repeatable, insurer-ready, and the key to better insurance outcomes.
With each and every insurance claim, you must include:
1. Accurate vehicle and ADAS diagnostic identification
Provide any scans, results, and how you found it (scanner, software, etc.). Include OEM guidelines for the ADAS system that you identified as in-need of calibration. Make sure to explain DTCs.
2. Calibration justification, procedure and results
Cite OEM guidelines, prove the work is necessary, that you followed the correct procedure, and that the calibration was successful.
Provide evidence of environmental specs and correct tool usage, along with any measurements found.
3. Invoices and pricing justification
Include clear line items, research fee charges, labor charges, programming fees, and parts costs, if applicable. Provide evidence from auto estimation platforms or quotes from other shops.
4. Everything labeled, organized, and consistent
These claims should be so clear that any shop could carry out the calibration exactly as you had. An organized claims package and air-tight insurance documentation will improve claim approvals.
How Revv ensures your documentation is up to par
Revv streamlines your documentation and reduces the chance of partial payments by:
- Autogenerating comprehensive documentation: When you enter a vehicle’s VIN, Revv identifies all required calibrations, including OEM guidelines and OEM-compliant documentation for those calibrations.
- Improving communication across teams: No more gaps in a calibration process that used to hurt insurance claims.
- Creating insurer-ready invoices: Autogenerate professional invoices that include all necessary information and stand up to insurance scrutiny.
- Keeping you current on OEMs: No matter the changes in the industry, you will always have access to the current guidelines and requirements of which you can pass on to insurers.
Reducing partial payments is just a few steps away
Repeated partial payments point to a documentation gap, insurers are not out to get you.
The best strategy is aligning your documentation process with insurer expectations. Always leverage OEM requirements and outcomes become more consistent.
Want to tighten your documentation strategy that avoids denials? Set up a conversation with one of our ADAS experts to refine your workflow.
