White Paper

The Auto Payers’ Checklist for Selecting a Pharmacy and Ancillary Program to Manage Claims

While auto and workers’ comp insurers see many of the same kinds of claims, handling auto claims takes a specialized knowledge base to reach the best outcomes for payers and patients.

White Paper Summary

When someone is injured in an auto or workplace accident, what happens next? That depends on the state, due to differences in regulations, legislation, and requirements. While industry expertise is helpful for managing both auto and workers’ comp claim types, there are substantial differences between them. Auto adjusters need specialized knowledge and resources that are tailored for the claims they manage.

While the core question in workers’ comp is whether the person was injured on the job, the auto side can be more complex.

As A.J. Carrier, AVP of Account Management with Optum Auto No-Fault (Optum),  explained, “Eligibility questions are often the first hurdle of auto claims.” He added, “In a motor vehicle accident, the first question is, was the policy holder in the car? Then, if they weren’t in the car, did the person driving the car have permission to do so? Were there passengers, and were they injured? Depending on the state, do the passengers have coverage that might be primary?”

That’s a real challenge in the auto industry. The claims are complex because there’s so much work that needs to be done before you can even consider whether there’s an eligible claim to manage.

Payers understand the intricacies involved in managing auto claims, but it’s really important that their business partners — like those who provide their pharmacy and ancillary benefits programs — do as well.

Optum understands. To demonstrate, Carrier and Melissa Dillingham, Optum Senior Account Manager, outlined key considerations for selecting a Pharmacy and Ancillary Program partner.

To learn more about Optum, please visit their website.

The Optum workers’ compensation and auto no-fault division works to collaborate with our clients to deliver value beyond transactional savings while helping ensure injured parties receive safe and effective clinical care throughout the life of their claim. Our innovative and comprehensive cost management programs include pharmacy care services, ancillary benefit management, medical services, and settlement solutions.

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