C
ost Proposal – City of Foster City
P age 1
S ubmission Date – April 10, 2025
7. C
ost Proposal Cost Proposal Based on your understanding and recommendations, Respondent shall submit a fixed- price cost proposal reflecting a bottom -line price to deliver all the services requested under this solicitation for the three -year duration of the Agreement. The fixed costs shall be inclusive of all costs and materials for preparing the scope of service. No payment will be made for any other expense or cost. Respondent shall provide sufficient detail/description in its cost proposal for the City to evaluate the overall quality of the proposed service.
W
e would be happy to discuss one bottom -line price, but do not recommend that approach. LWP suggests one fee for all claims adjusting, but separate charges for ancillary services, including b ill re
view, Utilization Review, Nurse Case Management and invest igations. LWP utilizes those services so infrequently that we believe any bottom -line estimate will actually cost the City more than our recommended approach.
Claims Administration - Life of Contract Claims Administration and Managed Care Option 1 - New Claims Only
Indemnity $500 per claim (set-up fee, including 1st month of handling) + $125 per month/per open indemnity
claim
Monthly fee reduced to $75 per month once claim
becomes “Future Medical” (after Permanent
Disability is resolved)
Medical Only Claims $275 per claim (one time fee)
First Aid Claim $50 per claim (one-time fee)
Option 2 - Including New and Takeover Claims
7/1/2025 - 6/30/2026 $79,000
7/1/2026 - 6/30/2027 $81,370
7/1/2027 - 6/30/2028 $83,811
Services billed monthly at 1/12 of annual cost
Fees assume use of LWP Cost Containment/Managed Care Services Services Included in Claims Administration Fee
Claims Administration Designated Account Manager
Claim Review Meetings Litigation Management
Reporting to Excess Carrier
Notes:
C
ost Proposal – City of Foster City
P age 2
S ubmission Date – April 10, 2025
• Set up fee is charged in the first month of LWP’s handling. • Monthly fee for indemnity claims will convert to the lower Future Medical fee in the month following final approval of resolution of permanent disability.
Annual Administration Fee
Annual Administration Fee $2,000
Bank Charges (one account) Included
Does not include outgoing ACH Payments
Storage Fees Included
On-Line 5020 Reporting Included
Loss Reports Included
On-L ine System Access 4 users included ($250 per user-year for additional users)
Trust Accounting Included
Preparation and filing of 1099's Included
FROI/SROI Reporting Included
Medicare Reporting Included
Cost Containment and Managed Care Services
Medical Bill Review Fee
Standard Medical Bill Review Fee Schedule
Reductions $9.00 per bill plus PPO Reduction
I npatient hospital and Ambulatory Surgery
Center
$400 per bill plus PPO Reduction if original charges
are greater than $300
PPO Reduction 24% of Reduction below Fee Schedule
27% Anthem Only
Bills not subject to Fee Schedule 24% of Reduction
File Indexing
Index and OFAC Reporting (ISO Fee passed
through) $22.50 per claim
Rate adjusted annually
E-Bill
E-B ill Fees $2.00 per bill submitted by a provider through a clearinghouse
Case Management
C
ost Proposal – City of Foster City
P age 3
S ubmission Date – April 10, 2025
Telephonic Case Management $104 per hour
F ield Case Management $110 per hour + incidentals (including mileage, phone, tolls, parking, etc.)
Utilization Review
Adjuster Review No Charge
Tier 1 - Nurse Review $120 Flat Fee
Includes 3 medical request in a single review, set up, phone calls to physician, email notices to adjuster and letters to all parties including network providers. Fee applies to reviews approved by nurse or escalated to physician.
Tier 2 - Physician Review $235 plus nurse charge
Includes 3 medical request in a single review.
Reconsideration: $235 flat fee (up to 3 medical requests per referral) P harmacy Review $385 plus nurse charge
Includes unlimited medical request in a single review.
Reconsideration: $385 flat fee
Medical Provider Network Access (LWP Network)
PPO fee for savings below fee schedule and negotiations 24% There is no separate charge for medical provider access to LWP's proprietary network. Percentage of savings below fee schedule is the only charge.
Specialized Network Access (bill review charges do not apply) Durable Medical Goods $5 per bill network access fee
Expedited Diagnostic Testing $5 per bill network access fee Physical Therapy Network $5 per bill network access fee Pharmacy Network $5 per bill network access fee
These charges apply only if LWP's programs are utilized.
Investigation
Investigation
Investigative Services $95 per hour
SIU Related Services $105 per hour
Background Investigation $375 flat rate
Social Medial Investigation $375 flat rate
Background + Social Media at Discount $550 flat rate
Medical Canvass $525 flat rate
VeriFive Package of 5 services for claim verification at $800+ Discount
$1,550 flat rate
VeriFive Package includes 1. Background; 2. Social Media; 3. Medical Canvass; PLUS 4. SIU Review + Strategy Development; and 5. Recorded Virtual Statements inclusive of Evidence-Based Questions. Includes two statements; additional fees apply for add-on services.
Cost Proposal – City of Foster City
Submission Date – April 10, 2025
Plus expenses which can include, but are not limited to: mileage, database fees, DMV fees, court search fees, records, certified copies, tolls, parking, evidence storage, and transcription.
LWP makes every effort not to change pricing. Pricing guarantee for 18 months. Price subject to increase thereafter with advance notice.
• Contract terms and conditions may be negotiated during the agreement process. Respondents are encouraged to provide their best pricing.
Agreed
• Please e- mail the cost proposal separately from the rest of the Proposal to Diane Pitman at [email protected].