Insurance Repayment Req after nearly 3yrs

[leighf]

What is the name of your state (only U.S. law)? Missouri

My insurance company had an outside agency contact me and request I pay back over $2000 they over paid on a claim in June of 2005. They did not contact me until 6/08. Can they make me repay. They first contacted the place they overpaid and the place told them no, so they moved on to me.

[lkc15507]

Insurers can request refunds for overpaymet of claims. However, to my knowledge, in MO, that limitation is one year, unless the insurer is Medicare or Medicaid (they have virtually no limits, and most assuredly would collect from the overpaid provider). But, the operative thing here is that I gather from your post the insurer overpaid the provider and did not make remuneration to you. If that is the case, they have no claim against you. Unless, (and I am not implying anything), the provider reimbursed you and not the insurer for the overpayment for some reason, which I doubt. If that did happen, that you received a reimbursement that you had not paid out in the first place, yep, you could / would be on the hook. As long as you did not receive any money I think you should rest easy.

I am curious, and you don't need reply if you don't want, but I would like to know the basis of the overpayment / refund request that the insurer made to the provider. IE was it a contractual / adjustment issue, duplicate payment, network issue, or do you know? Also, do you know when the insurer requested the refund from the provider?

lkc15507

[ecmst12]

If they paid a bill that they shouldn't have to the doctor, OP is just as liable as if they paid her directly. After all, if they had not paid the doctor, she would have had to pay the doctor just the same.

I don't think there's any states that have a debt SOL as short as 1 year, and it wouldn't start running until the date the overpayment was discovered anyway.

[lkc15507]

I completely disagree. Insureds are responsible for payment to the provider. Not for reimbursement to an insurer when they **** up, unless the insured received money they were aware they should not have. The insured cannot make a provider return money. As far as the SOL of one year, I am not talking about the limitation on debt collection in general, I refer to the industry standard of an insurer requesting a refund from a provider. If that doesn't happen within one year of payment, then the insurer is SOL, and I don't mean statute of limitations only. lkc15507

[ecmst12]

If there's no contract between the provider and the insurance company, then there is no limitation other then the debt SOL. Industry standard is not legally binding.

If the provider refunded the insurance company, then the provider could then turn around and bill the insured for the amount that she is still legally responsible for, as long as there's no contractual write-off being mandated. I'm guessing this is a non-contracted provider though, because if there was a contract, then the provider would be obligated to refund the insurance company. So the end result in that case would be exactly what is happening here.

[lkc15507]

DUHHHH. What part of overpayment did we miss? If there was an OVERPAYMENT to the PROVIDER, then I don't think the insured owes ANYONE! Also, I think the poster said that the provider didn't refund anyone. Are you searching? I think I agreed that if the poster received money she is not entitled to, someone may have a claim, but, I sitll say that the insured is not responsible for the insurer **** up. The PROVIDER IS responsible to the insurer. The insured is not. Contract, no contract, I don't really give a ****. What is happening here is that the insurer is trying to erroneously recoup from the insurer for theilr own furck up!

[ecmst12]

I think that the insurance company paid a bill that they should not have paid, but the patient would still have been responsible for. In which case, recovering from the patient is perfectly appropriate. If this is something that the patient would NOT be responsible for, then it's not appropriate, but I doubt this is the case.

Until OP tells us what the overpayment is for and whether the doctor was contracted, it's all just speculation though.

[leighf]

Exactly what happened is my insurance company paid $3095.00 for a hearing aid in June of 2005. The hearing aid was $3095.00. I guess they did an audit and contacted the hearing aid place in Feb 2008 and asked for a refund. The hearing aid place laughed at them and said no. In June of this year I was at work & my cell rang & it was a collection agency wanting $2095.00 stating my insurance company hired them. Thinking it was a scam, I told them to send the info in writing. They finally mailed me a copy of the letter they mailed the hearing aid place as proof they were collecting the debt. I have a copy of the EOB from 2005 stating patient owes nothing. I faxed a letter to the collection agency today stating I would not be paying them because their letter states if I do not respond within 30 days they will seek judgement and I want to keep my good credit. I called to verify they received my fax and spoke with Lynette. She said they did. I asked if further action will be taken and her quote was "I believe it is". I have called three lawyers offices in town and am hoping the third will call me and have filed a complaint on the BBB website. If I can get help finding the law, I can fight this. I just don't know how to start. I appreciate help. I think this answers all the questions. Thanks to everyone!

[leighf]

I forgot to add. I never saw a penny of the money- it went directly to the hearing aid center.

[ecmst12]

Start by calling the insurance company and find out WHY the claim is now being denied after it was originally paid, and whether the hearing aid center was contracted with them at the time of the service.

[leighf]

Per the letter the insurance company sent to the hearing aid center, there is a maximum benefit amout of $1000 on the purchase of hearing aids. That is why they are asking for the difference of $2095. I found out the hearing aid center is contracted with the insurance company.

[Zigner]

Originally Posted by leighf

Per the letter the insurance company sent to the hearing aid center, there is a maximum benefit amout of $1000 on the purchase of hearing aids. That is why they are asking for the difference of $2095. I found out the hearing aid center is contracted with the insurance company.

So, you DO acknowledge that, per your agreement with the insurance company, you owe the money...

[ecmst12]

So, your insurance company made a mistake and paid too much money. That is not a crime, and they are allowed to recover the overpayment.

If the provider had paid the insurance company (which they probably should have done per their contract, but that has nothing to do with you), they would have just turned around and billed you for the same amount. And that bill would have been legal and you would have had to pay it just the same. So like I said, as far as your bottom line goes, it's all the same to you. Whether you pay the insurance or the doctor, you owe the money.

[lkc15507]

You are all taking the mantra of "the insured is always responsible" to an extreme. I still completely disagree that this poster owes the insurer a dime, much less $2,095. I don't care if it is 1 month, 1 year, 3 years, or 10 years post payment to the provider, the insured does not owe the insurer for their mistake as long as he / she is not is receipt payment. lkc15507

[moburkes]

Originally Posted by lkc15507

You are all taking the mantra of "the insured is always responsible" to an extreme. I still completely disagree that this poster owes the insurer a dime, much less $2,095. I don't care if it is 1 month, 1 year, 3 years, or 10 years post payment to the provider, the insured does not owe the insurer for their mistake as long as he / she is not is receipt payment. lkc15507

BUT, if the insured doesn't owe the insurance company then the insured owes the provider. The insurance company can subtract the overpayment from the provider's next check. At that point the provider will bill the OP.

Bottom line is that OP wil owe someone $2095 soon.