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John C | My insurance company paid for services at a certain level and say they paid too much, and want a refund.? |
They covered me at the same price for over 13 visits and now say I owe them.
Additional Details
They say it was their mistake. Why should i have to pay them back? If I knew it would cost mor, I would have not gone as much. |
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sarah314
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Yes, they can request the money back, if they have documentation showing that they overpaid.
I do have a question though - why are they asking for the payment back from you? Did they issue the initial payment directly to you? Are you using an out-of-network provider?
Normally, if the insurance company realized that they overpaid directly to the medical provider, then they withhold future payments to that doctor (or take back the money they already paid) to make up the difference.
If you were getting reimbursed directly for a service, I'm not sure if your insurance company will withhold the reimbursement for future services. (Technically they could, if you owe them money - I'm just not sure that they actually *would* do that. Their system probably isn't set up to catch a negative balance from an insured member before a check goes out, the way it would be with a doctor who owed them money.)
However, if you do legitimately owe them the money, then they can send you to collections and have it appear on your credit report.
Did they give you a reason why they said it was overpaid? If your medical provider adjusted the coding on their bill, that could lead to a different level of reimbursement. Just trying to figure out what the full story is here - it would be easier to give you an answer knowing 1) why you were getting the checks and 2) what the reason given for overpayment was. |
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preciousxbluexfairy
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Not sure if you're talking about car/medical/dental etc, but the same thing happened to me with dental. they said the price they paid initially was just an estimate, so when i paid the remainder i got another bill in the mail saying I still owed. When i called to see what it was all about, they said it was an estimate of coverage and that my plan didn't cover the type of work they did. i'm out 90 MORE DOLLARS. i hate insurance companies. it's all a big scam to make them more money. they expect you to read the fine print that you'd never even know existed. |
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Custo
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Yes you owe it. They will put you in collections.
& you need to be more specific... what is "a certain level"? Why would the amount change? Is that your benefit? Was their mistake made due to a misunderstanding or a keying error?
Regardless of fault, its not your money... |
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zazz235
 |
I suggest that you call them and explain exactly that to them. Say that after seeing what they covered on your first visit, you elected to go to more visits because you budgeted for it. Tell that that you are happy to change your schedule now that you know the true price, but that you think that them asking for a refund is unfair.
I've had conversations like this with the insurance company, and usually, after an hour on the phone, they agree to pay. |
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Patti B
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This is strange,I have never heard of this before..
Usually,when you buy insurance,they specify,,,,for how much..
Check your policy,word,for word....I really don,t think you are responsible.....Weird Company...P |
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Sparkles
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Tell them you will contact the state insurance commissioner and have this contested. Call them and discuss this problem with the state insurance commissioner's office as this is the branch who all problems and complaints with insurance company's are reported to for investigation. |
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TONI C
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Too bad for them. If they overpaid it wasn't your fault. Next time they will be more careful. Maybe it is time to look into a new insurance company. They can't get back what they paid out...report them to your attorney general. |
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