WHAT IS PROOF OF MARKET RATE?
The bulky packet with paid invoices and check stubs from other insurance companies you received in the mail was NOT SENT TO YOU BY MISTAKE. Under the California Labor Code, this packet is known as "Proof of Market Rate".
The California Labor Code states that the rate that an insurance company has to pay for a two (2) hour medical appointment should be $90, or MARKET RATE whichever is Greater.
In order to establish a market rate for each of our services, we must submit documentation to the claims administrator [person who handles the case at the insurance company], that includes a list of recent similar services performed and the amounts paid for those services (Title 8 Rules and Regulations §9795.3).
In other words, the Proof of Market Rate is a compilation of checks or check stubs from different insurance companies that are sent to a specific insurance company, along with the invoices to which the payments were applied. This packet is to show that other insurance carriers have paid us the market rate that we have established for our different services.
WHAT SHOULD YOU DO WITH THE PROOF OF MARKET RATE?
If your job is classifying the mail that arrives at an insurance company, all you need to do is forward the packet (along with ALL the attachments) to the adjuster in charge of the case. The first invoice of the packet will have the case information (client's name, client's SS#, employer, claim number, etc.).
Please do not separate the attachments for they pertain to each individual case. You should forward the packet to the adjuster as is.
If you are an adjuster, please keep this packet in the file of the case that it is being sent with. If an agreement can't be reached between the insurance company and Joyce Altman Interpreters, as a lien claimant, the case will be presented to a judge. In court, your defense attorney will be asked about the Proof of Market Rate packet. If you don't have it and we present proof to the judge that we sent it to you, it will put the insurance company in a position of disadvantage.
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We have tried to explain to you in detail about the concept of "Proof of Market Rate" through this web page. However, if you have any additional questions or are still not sure what to do with the packet that we sent you, call our office at (714) 838-0950.Thank you!