Insurance Co. Paid Bill...now Wants $$ Back

[tripletrouble]

What is the name of your state? NEW JERSEY BC/BS OF NEW JERSEY
paid a doctor for surgery in Mar 2004 for a surgery in Jan. 04... Now they sent me a letter in Sept. that they made an error and want the money back which is approx 9,000.00. They said my contract with my employers covers 80% and since I went to an out of network dr. -they shouldn't have paid 100%. so...any bills that I send to them they are deducting it from the money they say I owe them. Can they change their minds after a bill is paid?
Lauren

[JETX]

Originally Posted by tripletrouble

Can they change their minds after a bill is paid?

Yep.

I just can't figure out how people think that for some reason they should benefit from someone else's error. If the roles were reversed and you found that YOU had overpaid your insurance premium, do you really think it would be right for the insurance company to keep your 'error' and say 'Screw you!!". Of course you don't. So, why would you think you could keep their money???

[tripletrouble]

New Jersey
Firstly, I am not keeping the money. The doctor was paid in March. Money I had borrowed was repaid to the lender with interest after the bill was paid. now...6 months later the insurance co. said they made an error ???. My son is six ...what is next -are they going to say oh, we paid too much for his birth 6 yrs. ago...we want the money for that too. Everything has a limit...how far can they go...???Think if this was your bill.

[rmet4nzkx]

Did you get out of network approval for the surgery prior to surgery?

[JETX]

Originally Posted by tripletrouble

Firstly, I am not keeping the money. The doctor was paid in March. Money I had borrowed was repaid to the lender with interest after the bill was paid.

Okay, so you paid the bill.... but you still BENEFITED from the insurance company. Based on YOUR numbers (they want $9000 back, which is apparently the excess 20% payment, making the total bill something like $45k!! Is that right?? Must have been a pretty substantial surgery!!).

The insurance company paid $45,000 and was supposed to only pay $36k, with YOU paying the remaining 20% ($9k). By them paying YOUR 20%, you benefited from their error in that amount. That is the money you are trying to 'keep'.... the money YOU should have paid. And simply, you owe them the $9k that they paid on YOUR behalf in error.
Really pretty simple, huh???

My son is six ...what is next -are they going to say oh, we paid too much for his birth 6 yrs. ago...we want the money for that too. Everything has a limit...how far can they go...???

They have the right to demand, and expect, reimbursement for any overpayment for as long as the SOL (Statute of Limitations) allows in your state. Once the SOL has 'tolled', they lose any legal right to force you to repay.

Think if this was your bill.

If it was my bill, I would recognize the TRUTH and pay them the amount that they paid on my behalf..... in error!!

[tripletrouble]

Originally Posted by rmet4nzkx

Did you get out of network approval for the surgery prior to surgery?

New Jersey
Approval was not required by the insurance company, although in Sept. 03 they paid the preop visit in full. They were aware via phone call that my son was having tendon transfer due to a stroke. I wanted to make sure this type of surgery was covered by my plan. The surgery was scheduled for Dec. 03, then had to be changed because of the sur. schedule to Jan. 04.

[tripletrouble]

NEW JERSEY
The insurance never gave a reason why it is not paying the 20% at this time. This is why my bill is $9,000. I assume because it was over the reasonable and cost. charges, but it was never written to me. They never denied payment until after it was paid 7 months later.