MODULE 3: PROTOCOLS & ESTIMATES
Working Within Limits
Lesson 3.2 - The Billing Blueprint: Mold Edition
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The Billing Blueprint
The Common Situation
$25K
Protocol Scope
$10K
Coverage Limit
What do you do?
Can't ignore protocol. Can't force insurance to pay more.
Can't do $15K of work for free.
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The Billing Blueprint
Understanding the Gap
Protocol
= what's needed for proper remediation (IEP doesn't look at coverage)
Coverage limit
= max insurance will pay (policy contract)
These often don't match
The gap falls to someone - usually the customer
This isn't insurance being unfair. Mold is expensive. Limits are what they are.
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The Billing Blueprint
Strategy 1: Prioritization
Work with IEP to identify what's
most critical
Not all protocol items are equally urgent
Some IEPs will write
phased protocols
Ask the IEP: "If we had to phase this work due to coverage constraints, what's the highest priority?"
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The Billing Blueprint
Prioritization Example
Phase 1: Critical
$15K
Bathroom + closet
Active, severe contamination
Phase 2: Secondary
$10K
Bedroom preventive
Minor affected areas
Insurance covers $10K toward Phase 1.
Customer pays remaining $5K or Phase 2 waits.
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The Billing Blueprint
Strategy 2: Customer Payment
Customer is responsible for their property
Insurance helps, but limits are limits
This conversation happens
BEFORE work starts
If customer doesn't want to acknowledge responsibility or make a decision -
don't start work
.
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The Billing Blueprint
Customer Options
Pay the difference
- full payment at completion
Payment plan
- monthly payments, get it in writing
Partial scope
- just critical items covered by insurance
Third-party financing
- HELOC, personal loan, credit card
Wait
- save money, do work later
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The Billing Blueprint
The Coverage Limit Conversation
1. State the coverage:
"Your policy provides $10,000 for mold."
2. State the scope:
"The protocol requires approximately $18,000."
3. Explain the gap:
"Insurance pays up to limit. Remaining $8,000 is your responsibility."
4. Present options:
"You can pay the difference, we can discuss payment plans, or prioritize critical work first. What would you like to do?"
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The Billing Blueprint
Other Strategies
Limit increase request
- Customer asks insurance for more coverage (not always available)
Supplements
- For additional scope discovered, but can't exceed limit
Supplements only work if there's room within the limit. If limit is exhausted, supplement won't help.
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The Billing Blueprint
Document the Decision
Whatever they decide, get it
in writing
.
"Customer acknowledges estimated out-of-pocket
of approximately $8,000."
Your work authorization should already include
coverage limit acknowledgment language.
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The Billing Blueprint
Key Takeaways
Protocol scope often exceeds coverage - that's reality
Prioritize
with IEP help - phase the work if needed
Customer pays
the gap - have the conversation BEFORE work
Present
options
, let them decide
Document
everything in writing
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The Billing Blueprint
MODULE 3: PROTOCOLS & ESTIMATES
End of Lesson 3.2
Working Within Limits
Action Item: Prepare your coverage limit conversation script. Practice it.
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The Billing Blueprint