I am not a lawyer, but an experienced insurance biller in the state of California. I have used the following case examples for insurance companies who have tried to get back monies which they say were mistakenly overpaid. Bottom line is it is the insurance company's responsibility to know it's own policy limits, and if you did not intentionally overbill them they will be hard pressed to get it back. With this information, my office has never been required to repay an insurance company.
I would like to bring to your attention the cases of: InFederated Mutual Insurance Company vs. Good Samaritan Hospital, (Neb. 1974) 214 N.W.2d 493, where the court held that the insurance company could not recover the mistaken overpayment and determined that “the insurance company is in the best position to know what the policy limits are and must bear the responsibility for their own mistake.” As well as, The City of Hope National Center vs. Western Life Insurance Company, 2 daily journal D.A.R. 10728, Decided July 31, 1992, where the court held that, in the absence of fraud, a health care provider is not legally obligated to refund payments it receives from an insurer, if the insurer subsequently determines that they were paid in error.
