what is subscriber's liability for overpayment by health insurance co?

[pookie007]

What is the name of your state? Oregon

I am a United Healthcare subscriber. Under the terms of my policy, I can receive $8000/yr for infertility treatments, and a $24k lifetime maximum. In 2002 UHC erred and paid an additional $4400 toward infertility claims. $3500 was paid to a fertility clinic, $700 to acupuncturists and $200 toward blood tests. The explanation on the acupuncture was that they made a mistake; it is not covered for infertilty, nor are the blood tests, which UHC says are "experimental." The overpayment to the fertility clinic was an oversight.

Since I paid up front for the acupuncture and blood tests (and was reimbursed by UHC), I have rec'd a bill from UHC for the combined $900. The fertility clinic is being billed by UHC and told to return the $$; the clinic will then bill me for the $3500.

My question is, what liability do I have -- do I have to pay for UHC's mistakes? If I don't pay they will deduct the $4400 from future reimbursements. On the other hand, my husband is lining up a new job at a new employer (with new insurance) -- can I just bail on the UHC coverage? That would only solve $900 of my problem, since I would want to remain on good terms with the clinic so I'd still have to pay then. Any advice is appreciated, thanks.

Pookie

 

[cbg]

Frustrating as it is, you do not have a right to payments that are not covered by your policy. The fact that it was UHC's error does not mean that you have no liability. If they'd UNDERPAID you, you'd expect them to make up the difference, right? Why should it only work one way?

If they are asking for repaying of the claims paid in error, you need to repay them.

 

[pookie007]

Thanks for your assessment. I guess we'll have to bite the bullet.

Pookie