Debt Recovery

Turning broken glass into real cash (not just unpaid invoices)

If you run a glass shop or glazing company, you already know the pattern:

• Your crew rushes out for an emergency board-up.

• A windscreen gets replaced in a driveway at 7 a.m.

• A storefront door is fixed before the store opens.

The work is done on time, the customer is happy… and then you spend the next 60–90 days chasing the money.

If overdue glass invoices are quietly piling up, you’re not alone. Glass repair and replacement is a multi-billion-dollar industry, but many shops are still writing off a painful amount of small and mid-sized jobs every year.

If you’re tired of being an unpaid bank for your customers, it’s time to treat Accounts Receivable (A/R) as seriously as you treat safety glass.

Need a good debt collections agency: Contact us

Why glass repair invoices fall through the cracks

On paper, most glass jobs look simple: send estimate, do the work, send invoice, get paid. In the real world, several things go wrong:

• “Insurance will pay, right?”
  Customers often assume insurance is covering everything and are shocked by a high deductible or a coverage gap. Once the glass is in, they stop taking your calls.

• Mobile jobs with no one ready to pay
  Techs complete the job at home or on site, but the person with the card or authority to pay isn’t there. A “just invoice me” quickly turns into radio silence.

• Construction payment games
  For glazing contractors, invoices disappear into the Net 30 / Net 60 / retainage blender. You did your part, but the GC or owner is waiting on their own money—and you’re at the bottom of the priority list.

• Quality disputes (real or imagined)
  Noise, distortion, leaks, scratches on frames, or a door that doesn’t close quite right can delay payment, even if the underlying work is sound.

• Weak paperwork
  No signed work orders, fuzzy change orders, or vague scope language give customers excuses to stall or refuse payment altogether.

None of these problems fix themselves. Without a plan, your A/R just gets older, and older invoices become suggestions, not obligations in the customer’s mind.

The real cost of slow-paying glass customers

A lot of glass owners shrug at a few unpaid tickets. But run the math:

• Average auto glass job: $250–$600

• ADAS or high-end windshields: $800–$1,500+

• Small commercial/storefront work: $1,500–$5,000

• Larger glazing packages: $10,000–$50,000+

Now imagine every month you lose:

• 3 auto glass jobs at $400 each

• 2 small commercial invoices at $2,500 each

That’s $7,700 a month, or over $90,000 a year quietly leaking out of your business.

Add to that the time your office spends sending statements, making reminder calls, and arguing with adjusters. You’re not just losing revenue—you’re losing hours that could be spent booking profitable jobs.

Auto glass vs. commercial glazing: two very different A/R headaches

Glass businesses usually sit in one (or both) of these worlds, and each has its own A/R traps.

Auto glass and mobile glass services

• Insurance-driven work
  Jobs billed directly to insurance with the customer owing only the deductible. Trouble starts when:

  • Coverage isn’t what the customer expected

  • Deductibles are higher than they realized

  • Claims get denied or delayed

• Retail and fleet work

  • Retail customers sometimes ask to “be billed later” for mobile jobs.

  • Car dealers, body shops, and fleet accounts demand Net 30 or Net 60 terms and pay when it suits their cash flow, not yours.

• Customer psychology
  Once the glass is in, the urgency disappears—for them. For you, the clock just started ticking.

Flat glass, storefronts, and glazing contractors

• Construction payment chains
  Glass subs often don’t get paid until the GC or owner gets paid. “Paid when paid” or “paid if paid” language can push your invoices out for months.

• Retainage
  It’s common to see 5–10% retainage held until final completion and sign-off. That’s real money tied up because of punch-list delays.

• Change orders
  Extra openings, upgraded glass, faster lead times—these are approved verbally on site, installed, and then disputed later because nobody captured a clean change order.

• Owner cash-flow issues
  Some customers simply use you as a free line of credit. If you’re not firm, you’re the one financing their project.

Why unpaid glass invoices keep stacking up

A few root causes show up again and again in glass and glazing:

1. No clear payment policy
   Terms, deposits, and late-payment consequences are vague or missing from estimates and invoices.

2. Too much trust, too little structure
   “We’ve worked with them for years” turns into months of chasing an overdue account when that customer hits a cash crunch.

3. Slow follow-up
   Invoices age quietly because nobody owns the follow-up process. Calls start at 60 or 90 days instead of at 5–7 days past due.

4. Fear of losing the customer
   Owners delay firm action because they don’t want to upset a GC, fleet manager, or property owner—even though that client is already costing them money.

5. No escalation path
   Staff keep trying the same friendly reminder long after it stops working. There’s no process to move accounts from gentle reminders to serious collection.

Legal tools glass companies can use (without becoming a lawyer)

You don’t need to practice law, but you should understand the outline of your options when customers still don’t pay.

Mechanic’s liens on buildings and storefronts

For commercial and construction work, a mechanic’s lien can be one of your strongest tools:

• It creates a legal claim against the property you improved (e.g., a storefront, office, or building).

• Owners usually can’t refinance or sell easily without dealing with recorded liens.

• Knowing you are willing and able to use lien rights often gets your invoice moved up the priority list.

Important:

• Lien rules are very state-specific.

• You usually must send a preliminary notice and file within strict deadlines.

• If you miss those dates or file incorrectly, your lien can be invalid.

Use wording like “Talk to a construction attorney or lien service in your state” in your contracts and internal procedures, and treat lien deadlines as sacred.

Vehicle liens and possessory rights

Some states give auto repair shops a form of mechanic’s or artisan’s lien on vehicles:

• In some places, you may have the right to hold a vehicle until paid, or even auction it after following proper steps.

• In others, rules are more limited or heavily regulated.

Because this area is sensitive, keep it high level in your messaging and always confirm specifics with a local attorney.

Small claims court and judgments

For smaller jobs:

• Small claims court is often the most practical legal option if reminders and collections fail.

• A judgment can sometimes be enforced through wage garnishment or bank levies, depending on state law.

Legal tools are the last mile of your strategy, not the first step—but it helps to know they exist.

When it’s time to hand glass invoices to a collection agency

A good collection partner doesn’t just “chase people.” They:

• Know how to speak to consumers, property owners, and contractors in a firm but professional way.

• Understand how glass jobs, construction draw schedules, and insurance claims actually work.

• Have tools like skip-tracing, structured call campaigns, and payment plan management that your office doesn’t have time to run.

Typical triggers for placement:

• No response after 2–3 solid follow-ups

• Disconnected phone numbers or returned mail

• Customers making endless promises but never paying

• Commercial clients that are happy with your work but constantly pay 60–90+ days late

By the time an invoice is 120 days old, your odds of getting paid drop sharply. Moving accounts to collections earlier—when they’re still relatively “fresh”—usually results in higher recovery and fewer total write-offs.

FAQs: getting paid for glass repair and glazing jobs

How long should I wait before sending a glass invoice to collections?
For most consumer and small commercial jobs, many glass businesses aim to send accounts to collections around 60–90 days past due if reminders haven’t worked. For larger construction jobs, timing may be tied to mechanic’s lien deadlines and contract terms.

Can I file a lien if a customer doesn’t pay for window or storefront work?
In many places, yes—if you’ve supplied and installed glass or glazing that improved the property and you follow your state’s notice and filing rules. Because lien law is technical and state-specific, talk to a construction attorney or lien service before relying on this.

What should I send to a collection agency for a glass invoice?
At minimum, provide:

• Signed estimates or work orders

• Invoices and statements

• Proof of completion (photos, delivery notes, job tickets)

• Any emails or texts about changes or warranty work

The stronger your documentation, the easier it is for an agency to collect.

Will using a collection agency scare off my good customers?
Handled poorly, yes. Handled well, no. A professional agency focuses on firm, respectful communication and payment solutions, not harassment. Most serious customers understand that if they ignore multiple reminders, the account will eventually be escalated.

Should I sue or use collections for small auto glass jobs?
For small tickets (e.g., under a few thousand dollars), collections or small claims court are usually more practical than full-blown lawsuits. Many shops reserve lawsuits for larger commercial or construction disputes and rely on a collection agency for smaller, repeat-pattern debts.

Need a good collections agency: Contact us

How Nexa helps glass businesses recover what they’re owed

If you’re seeing more “broken promises” than broken glass, it’s probably time to rethink how you handle overdue invoices.

Nexa is an information portal that helps businesses—including glass repair shops and glazing contractors—find suitable collection agencies for their type of A/R. We are not a collection agency ourselves and we don’t collect money from your customers. Instead, we:

• Ask about your average job size, customer mix, and A/R problems

• Shortlist reputable, compliant collection partners that understand construction, insurance, and trade businesses

• Leave it completely up to you whether or not to work with them

If overdue glass invoices are becoming a monthly headache, share a few details about your situation. You focus on making glass look perfect—we’ll help you move closer to getting every job paid in full.

You are a 24/7 emergency service. You deploy thousands of dollars in equipment and labor to solve a crisis, but you get paid on a timeline that creates one.

In the restoration industry, getting paid isn’t as simple as sending an invoice. Your cash flow is held hostage by skeptical insurance adjusters, complex “scope of work” disputes, and homeowners who treat your payout like a windfall.

Nexa Collections is the partner you need to break this cycle. Rated 4.87/5 on Google, we are not just a collection agency—we are a specialized revenue recovery firm.

We understand the difference between a “Class 1” and “Class 4” water loss, and we know how to explain it to a reluctant debtor.

The “Insurance Check” Problem (And How We Solve It)

The most frustrating loss in this industry is when the carrier mails the large payout check directly to the policyholder… and the homeowner spends it.

• The Reality: Industry data suggests that over 30% of restoration bad debt stems from homeowners misappropriating insurance funds.

• Our Solution: We treat this not as a simple debt, but as misappropriation of funds. Our collectors are trained to firmly explain the legal severity of keeping insurance money meant for contractors. This leverage often secures immediate payment from homeowners who are “ghosting” you.

Why Restoration Pros Trust Us

• We Speak Your Language:
  From Xactimate estimates to AOB (Assignment of Benefits) contracts, we understand the documentation that proves your debt is valid.

• Mortgage Endorsement Help:
  A common delay is when a check requires a mortgage company’s endorsement. We help facilitate this process to get the funds released faster.

• Reputation Protection:
  Your “customer” is often a neighbor in your local market. Our approach is firm but professional, ensuring you get paid without damaging your local reputation.

What We Recover

We handle the full spectrum of restoration receivables:

• ✅ Unpaid Deductibles: The $500–$2,500 gap that homeowners often refuse to pay.

• ✅ “Ghosted” Insurance Checks: Recovering funds the homeowner cashed and kept.

• ✅ Emergency Mitigation: Collecting for water extraction, board-ups, and tarping.

• ✅ Reconstruction Costs: Final bill payments after the rebuild is complete.

• ✅ Supplement Disputes: When the carrier approves additional work but the homeowner keeps the difference.

Our 3-Step Process: Beating the Lien Deadline

In restoration, a Mechanic’s Lien deadline is your ticking clock. We work fast to recover your funds before you are forced to file a lien, saving you legal fees and headaches.

1. Investigation & Skip Tracing

We verify if the insurance carrier has actually paid the claim. If the homeowner has moved (common after a major fire or flood), our skip-tracing tools locate them instantly.

2. Strategic Demands & Credit Reporting

We use a multi-channel approach. Crucially, we can report the debt to major Credit Bureaus. A negative mark on a homeowner’s credit report is a powerful motivator—especially if they are trying to refinance to pay for repairs or sell the home you just restored.

3. Negotiation & Mediation

Whether it’s a dispute over “dry logs” or a homeowner refusing to sign a Certificate of Satisfaction, our specialists act as mediators to cut through excuses and secure full payment.

Frequently Asked Questions

Q: Can you collect if I didn’t get a signed contract?

A: It is harder, but possible. If you have text messages, emails, or proof of work (photos/dry logs) showing the homeowner allowed you to work, we can often build a case for “Unjust Enrichment.”

Q: Do you charge upfront fees?

A: No. We operate on a contingency basis. No Recovery, No Fee. If we don’t collect your money, you don’t owe us a dime.

Q: Can you help with small deductible balances?

A: Yes. We have a specialized team for low-balance accounts. Recovering ten $1,000 deductibles adds $10,000 back to your bottom line.

Stop Financing Your Customers

Your job is to restore homes, not to act as a bank for insurance payouts. Let us handle the recovery so you can keep your crews rolling.

Get a Free Restoration Quote

A collection agency is not a “low-bid vendor.”
It’s a business partner trusted with your brand, your customer relationships, and your cash flow.

Choosing an agency the way you’d choose the lowest-priced plumber is one of the fastest ways to lose money twice:
first in unpaid balances… and then in bad recovery performance.

Here’s the reality: collection agencies know exactly what their competitors charge.
So when you see an agency offering rock-bottom contingency fees, ask the obvious question:

How are they funding the work it takes to actually recover your money?

Because the fee is not the goal.
The recovery is the goal.

Why “Low Fee” Can Mean “Low Recovery”

Agencies that charge higher contingency fees aren’t foolish.
There’s a reason they can justify it: they invest more effort and better talent into recovering accounts.

A good collector is in high demand.
They don’t work harder for less. That’s not how the world works.

When an agency agrees to collect at too-low contingency fees, it often signals one of these problems:

• They can’t afford strong collectors

• They don’t devote enough time per account

• They run a “volume machine” (quantity over quality)

• They cut corners on compliance and supervision

• They create reputation risk for you

• Their data security is not up to mark. Collection agencies are required to have bank level GLBA secure systems. Unfortunately, not all collections can effort it, putting them and you at risk.

And if the agency uses inferior-quality collectors, your business reputation becomes the collateral damage.

Collection Agencies Have High Overhead Costs (For Good Reason)

Let’s break down what a serious collection operation actually costs.

• Experienced, top-tier collectors are expensive.
  Most collectors are commission-based contractors. They earn a percentage of what they collect.
  If the agency’s contingency fee is too low, the collector’s earnings shrink—so the best collectors won’t stay.

• Supervision + professional workspace matters.
  A well-run operation needs oversight, support staff, training structure, and the right equipment.
  Ask yourself: do you want low-wage collectors working from home, or overseas, handling your accounts?

• Ongoing training on Federal + State laws is non-negotiable.
  Collection laws change. Scripts change. Call practices change.
  Agencies that don’t train regularly risk violations—and your brand absorbs the blowback.

• Secure data handling + annual security audits are not cheap.
  You share sensitive customer information. Secure systems means money, hiring an inhouse IT security engineer.
  If a third-party agency gets breached, imagine the liability and chaos for your company.

• Skip tracing and recovery tools cost money.
  Effective recovery requires subscriptions to real services—advanced skip tracing, not “basic tracing for the namesake.”

• Being licensed, bonded, and insured costs money.
  Protection against counter-lawsuits isn’t optional—it’s operational hygiene.

• Client portals, reporting, document uploads = IT costs.
  A professional system for submitting accounts, monitoring progress, and running performance reports requires investment.

Bottom line:
Hiring a collection agency just because it offers rock-bottom fees—without investigating further—can be costly.
You often get what you pay for.

Optimum Collection Fees (What’s “Too High,” “Too Low,” and “Just Right”)

This is what we consider generally healthy contingency pricing.

For Consumer Collections (B2C)

• Over 50% contingency is usually unacceptable and too high
  (unless the debt is more than 2 years old and extremely difficult to collect)

• 50% is slightly on the higher side

• 45% to 50% is considered acceptable

• 35% to 45% is typically the sweet spot for a strong agency

• Below 35% may be too low unless the balance is over $10,000

Performance Beats Fees (Simple Math, No Drama)

Let’s say you assign a balance of $10,000 to a collection agency.
You have two options: Agency A and Agency B.

Agency A

• Charges 40% contingency

• Recovers 50% of the balance (recovers $5,000)

• You receive $3,000 after fees

Agency B

• Charges 25% contingency (sounds amazing on paper)

• Recovers 30% of the balance (recovers $3,000)

• You receive $2,250 after fees

Performance wins.
Any business owner would pick Agency A.

Because you don’t deposit “low contingency fees” in your bank account.
You deposit recovered dollars.

Let Me Repeat (Because This Is Where People Get Tricked)

Collection agencies know their competitors’ pricing.
They don’t charge higher fees “just because.”

They charge higher because:

• the work is harder than it looks

• good collectors cost more

• compliance requires constant investment

• recovery performance takes time and talent

Now, to be fair:
Not every low-fee agency is automatically bad.
And not every higher-fee agency is automatically great.

But if an agency is offering a rock-bottom rate, ask why.
Ask what you’re getting for that price.
And make a mindful selection.

For Commercial Collections (B2B)

Commercial accounts typically involve higher balances and more complexity, so pricing works differently.

• Contingency fees are typically between 15% and 35%

• A collection agency will give you a quote depending on:

  • the balance size

  • the age of the account

  • the complexity of the case

• There is no fixed fee in most B2B commercial scenarios

Final Thought

The cheapest agency is rarely the one that returns the most money.
In collections, “cheap” can quietly translate into:

• fewer attempts

• weaker collectors

• lower recovery

• higher reputation risk

• bigger losses over time

So don’t hire based on fees alone.

Hire based on performance, professionalism, and protection of your brand.

Is your company constantly losing money due to overdue accounts receivable? Several delinquent accounts have remained uncollectable despite your best efforts or even when you followed all your company-recommended procedures and policies. Furthermore, chasing customers to clear their bills wastes too much time. This keeps your team members away from the core business responsibilities they were hired for.

Did you notice that 75% of the accounts which become over 90 days past due never get resolved unless outsourced to a professional collection agency?

Why should your company hire a professional collection company?

We have prepared a list of “Frequently Asked Questions” that will help you genuinely address your concerns and also help you design a strong case for your company’s senior management.

1. What is the expense involved in hiring a collection agency?

>> None – Accounts can be submitted for contingency collections. Therefore there are no upfront costs. A collection agency returns 60% of the money recovered and keeps 40%.  Many collection agencies offer flat-fee services too, starting at $15 per account.

For commercial collections (B2B), contingency rates are lower. Collection agencies also offer first-party pre-collection services if your staff hardly gets time to follow up on delinquent accounts.

2. Which accounts would you transfer for collections?

>> Only those accounts that have not paid for more than 60 days should be transferred. In other words, you have given them at least two billing cycles to pay directly to you.

3. Any other financial benefit to the company?

>> Many. Almost 90% of these accounts over 90 days past due are written off as a loss. The effort and cost involved in following up offsets the recovery made on them. In short, our company is not gaining anything by following up on accounts over 90 days.

On the other hand, money recovered by a collection agency will be 100% profit for the company.

4. Would you need more people to follow up with a collection agency?

>> Not at all.  Employees will have more time in hand as they won’t have to waste time on these hard-to-collect accounts. Only 1-2 existing employees would spend 15-30 minutes daily submitting past-due accounts on the collections agency website.

In-house employees hate doing debt collections anyway. It will also alleviate the pressures on your billing department. 

5. Why can’t you do the same thing internally?

>> No, you cannot replicate what professional collection agencies can do. Collection agencies have advanced tools that assist in collecting money from hard-to-collect accounts.
They do Skip Tracing to locate missing debtors.
They also perform Bankruptcy checks and several other checks that assist in recovering money.
They do debt collections every day and can handle collections efficiently and effectively.
Collection agencies are also aware of the ever-changing Federal and local laws involved in debt collection.

6. Is there any security risk if you hire a collection agency?

>> Accounts are submitted using a secure website.

The agency will additionally provide security certifications to ensure the data is handled securely. Collection agencies are licensed, bonded, insured, and diplomatically perform collections. This dramatically reduces the company’s own risk against potential lawsuits.

7. 40% contingency fee. Should you look for a cheaper agency?

>> 40% is a reasonable fee in the collections industry. All “good” collection agencies charge between 40%-50%. Moreover, if your average balance is over $1000, the contingency rate can be lowered to around 35%. Hiring a collection agency with better returns is more important than going for the cheapest. Lower-cost agencies do not spend enough time and tools required for higher returns. 

8. How long will it take to set up?

>> Just one business day after the contract with the agency is signed, another 1-2 days to train in-house employees to get used to the process. You will be up and running in less than 3-4 days. 

9. Why should you move fast?

>> The success rate of collecting from older accounts reduces significantly over time. The probability of collecting money falls about 10% every month. By waiting, our company is only losing money.

10. Would it upset our customers?

>> Chances are low. The Fair Debt Collection Practices Act (FDCPA) is the primary federal law that governs debt collection practices. The FDCPA prohibits debt collection companies from using abusive, unfair, or deceptive practices to collect debts from debtors. All collection efforts are made diplomatically with the intent to preserve relationships.

A collection agency will also try to build a positive relationship with your customer, which will help prevent non-payment issues from reoccurring in the future.

11. Why would a client pay a collection agency versus when you ask them to pay you directly?

>> That’s indeed a fact. People are much more fearful/concerned when a collection agency is involved. They know that a collection agency will not back off quickly. For reasons beyond the scope of this article, a simple fact is that people indeed dig their pockets deeper to pay off a collection agency.

12. Which agency should you select? With Local or National presence?

>> The location of a collection agency does not matter, but they should be licensed in your state and where your debtors reside. A collection agency with a nationwide presence should be preferred. If a debtor crosses state lines, you won’t have to look for a new agency to pursue that debt.

13. Do they keep your money collected in a Trust Account:
Always select a collection company that deposits all money collected for creditors in a separate bank Trust Account.

Fill out our “Contact us“, and we will simplify this process.

Conclusion:

Companies do not even realize that they often spend “more money” trying to collect. This is primarily due to the lost time of employees, resources, and many other hidden costs.

If you feel transferring an account to a professional debt collection agency after 60-90 days is cost-effective for your organization, you are 100% right. Collection agencies have been around for decades, and every year they recover billions of dollars for organizations like yours, which cannot collect money from those hard-to-deal-with customers.

It is common for organizations to focus only on getting new customers and mostly ignore their past-due accounts. Engaging an outside organization for debt collection requires approval from upper management, CEO, CFO, or business owner. The concept of transferring accounts to a collection company is prevalent. Even Fortune 500 companies hire a collection agency.

Standard debt collectors dial phones. We fight audits.

If you have received a demand letter from an insurance payer asking for money money back—or worse, if they are already withholding funds from your current checks to pay off an “old debt”—you are facing Recoupment.

This is not a collections issue. It is a legal and compliance dispute. Treating it like standard bad debt is why most practices lose these battles.

At NexaCollect, we don’t just ask them to stop; we audit the auditors.

Need a Collection Agency? Contact us

Why Switch? The “Takeback” Letter is Not a Bill.

Most collection agencies operate on a simple model: they harass patients to pay $50 copays. But when UHC, Aetna, or a Medicare MAC demands $50,000 back because of an “alleged coding error” from two years ago, a standard agency is useless. They cannot argue ERISA law, and they cannot audit a CPT code.

The Landscape Has Changed in 2026:
Insurance payers are now using AI-driven “Predictive Overpayment” models. In 2024 alone, initial claim denial rates spiked to 11.8%, and automated recoupment demands increased by over 20% in the commercial sector. They are using algorithms to find patterns and demand bulk refunds, hoping you are too busy to fight back.

The Nexa Difference:

• Force Multiplier for Billing Staff: Your billing team is built to submit new claims, not fight forensic legal battles on old ones. We handle the heavy lifting so they don’t burn out.

• Reputation-Safe Dispute Resolution: We argue on regulatory and contractual grounds—never aggression. This preserves your contract status with the payer while protecting your bank account.

• The “Investigation” Shield: Under the revised CMS 60-Day Rule (effective Jan 1, 2025), proper investigation protocols can pause the refund clock for up to 180 days. We know how to trigger these pauses to buy you time and leverage.

The “Takeback” Danger Zone: 3 Risks of Waiting

1. Statute of Limitations: Many states have strict “clawback” windows (often 12–24 months). If you don’t initiate the recoupment professionally and quickly, the money is legally gone.

2. Provider Resistance: Providers often view recoupment as a “hidden tax.” Our mediators bridge the gap, explaining the data clearly to reduce friction.

3. Offsetting Complications: While future payment offsetting is common, it can lead to reconciliation nightmares. Direct recovery through Nexa keeps your books clean.

Q&A: The Executive Guide to Recoupment Defense

Q: Why does a collection agency letter work when my rebills failed?

A: It triggers a “Statutory Countdown.” When you simply resubmit a claim, it goes back into the automated claims queue—often to be denied by the same algorithm. A Legal Demand Letter is different. It is classified as a “Pertinent Communication” under state Unfair Claims Settlement Practices Acts.

• The Shift: It forces the carrier to route your claim out of the automated queue and into the “Dispute Resolution” or “Legal” department.

• The Timer: In most states, once this letter is received, the carrier is legally required to respond within a stipulated timeframe (typically 15 to 30 days). If they ignore it, they risk “Bad Faith” litigation penalties.

• The Result: Your case is finally prioritized and reviewed by a human specialist, not a bot.

Q: Is it legal for them to just take money out of my current checks?

A: Often, yes—but they must follow strict procedural rules. This is called “offsetting.” However, under ERISA laws, if the original plan was self-funded (which many employer plans are), the insurer may not have the right to offset funds from a different patient’s claim to pay for the first one. We audit every offset to ensure they aren’t robbing Peter to pay Paul illegally.

Q: How far back can they go?

A: It depends on your state and your contract.

• Commercial Payers: Usually limited by state “Lookback Periods.” For example, Florida generally limits recoupment to 30 months, while Texas prompt pay laws have a 180-day limit for certain clawbacks. If your contract is silent, general state statutes of limitation (often 4-6 years) might apply.

• Medicare (RAC Audits): Generally 3 years, but can go back further if “fraud” is alleged (which they use loosely).

• The Defense: We frequently get demands thrown out simply because they violate the “Lookback Period” by even one day.

Q: Can we fight a “Medical Necessity” recoupment?

A: Absolutely. These are the most common and the most beatable. Payers often use automated “black box” algorithms to deny care as “not medically necessary” without a human doctor ever reviewing the chart. We force them to produce the clinical credentials of the reviewer. If an algorithm made the decision, we challenge the validity of the audit itself.

Recent Results:

We do not use hypothetical examples. These are real scenarios handled by specialized defense teams.

Scenario A: The “AI Algorithm” Mass Sweep

• The Threat: A mid-sized Surgical Center received a bulk demand for $420,000. A major commercial payer’s AI algorithm flagged every instance of a specific CPT modifier used over the last 18 months, claiming it was “unbundled” incorrectly.

• The Defense: We utilized the No Surprises Act dispute framework and clinical coding guidelines to prove the AI failed to account for the specific anesthesia time units associated with the procedure.

• The Result: The demand was reduced to $12,500 (a 97% reduction) after we proved the vast majority of claims were compliant.

Scenario B: The “Silent” Offset

• The Threat: An Out-of-Network provider noticed their revenue dropped by 15% overnight. The payer had silently begun withholding $15,000 per month from current checks to satisfy a disputed overpayment from 2021 regarding “Usual and Customary” rates.

• The Defense: We issued a legal demand citing a breach of ERISA procedural requirements, specifically the failure to provide a “Full and Fair Review” before commencing recoupment (citing Montanile v. Board of Trustees precedents).

• The Result: The offsetting stopped immediately. The $85,000 already withheld was returned to the provider, and the original dispute was moved to mediation.

Ready to Stop the Bleeding?

A recoupment demand is a time-sensitive legal threat. Every day you wait is a day the “Lookback Period” might expire or the “60-Day Rule” might lock you in.

Do not let them audit you into the red.

Get a Free Audit Defense Consultation

When a third-party collection agency contacts an insurance company, the insurer is reminded of its obligation to pay claims promptly. Failing to resolve medical insurance claims on time can result in a violation of state law.

Once an insurance company receives a collection notice from a professional collection agency, they are under pressure to act fast.

These laws and payout periods vary from state to state in terms of operation, complexity, and severity. However, they all share the common goal of compelling insurers to promptly and fully pay all legitimate claims. Debt issues in the BSFI market are anticipated to grow significantly over the next 10 years.

Non-timely reimbursements is a leading cause of stress and burnout among medical professionals, then why not outsource unpaid medical insurance claims to a professional agency and get paid faster.

Examples of “prompt-pay statutes” law in some states.

Texas Insurance prompt payment statute:
The Texas Prompt Pay Act (“TPPA”) is codified in the Texas Insurance Code as Subchapter J of Chapter 843 (governing health maintenance organizations (HMOs)) and Subchapters C and C-1 of Chapter 1301 (governing preferred provider organizations (PPOs)).

California prompt payment statute:
California Health & Safety Code 1371. A health care service plan, including a specialized health care service plan, shall reimburse claims or a portion of a claim, whether in-state or out-of-state, as soon as practicable but no later than 30 working days after receipt of the claim by the health care service plan, or if the health care service plan is a health maintenance organization, 45 working days after receipt of the claim by the health care service plan.

Florida Insurance prompt payment statute:
Florida statute 627.6131, otherwise known as the “Prompt Pay Statute,” requires insurance companies to make decisions and pay out on claims quickly. The timeframe created by this legislation depends on how the claim was received, either electronically or physically.

New York State prompt payment law health insurance:
Law § 3224-a (McKinney 2000) requires payment of health claims by health insurance companies within 45 days of receipt of such claim; N.Y. Ins. Law § 5106 (McKinney 2000) requires motor vehicle no-fault providers to pay health claims arising from vehicular accidents to be paid within 30 days of receipt of such claim.

North Carolina: 30 days for payment or denial.

North Dakota, Georgia: 15 days

Ohio, Oregon, Delaware, Idaho, Kansas, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Montana, Nevada, Wisconsin: 30 days

Oklahoma, Colorado, Pennsylvania, Missouri, Nebraska, Vermont, Virginia, Wyoming: 45 days

Alabama, Arkansas: 30-45 days

Arizona: 30 days after the claim is approved

Louisiana: 25 to 45 days

Mississippi: 25-35 days

( days refer to “working” days)

References:
www.tlrfoundation.com/sites/default/files/pdf/TLR_Prompt_Pay_PDF_V01.pdf
danahyandmurray.com/florida-prompt-payment-statute/
www.dfs.ny.gov/insurance/ogco2002/rg207242.htm