A little background.
My internist ordered some labs in September 2011. I had them done that month and the lab submitted their bills to the insurance company. Because the lab was not contracted with Blue Cross, my insurance company sent the checks directly to me. I then forwarded all of the checks to the lab.
Fast forward to this month and the insurance company is asking for all of the money back. CRAZY.
My question is, A) Has anyone ever had this happen? If so, what was the outcome?
And B) How the heck are they allowed to ask for money back that they paid on? That doesn't seem legal to me.
Thanks in advance.
I had this happen. They sent the payment to me for some reason with the EOB and they paid the medical bill as well. They had to go to the medical office to get the money back since they paid twice.
Did you call and ask them WHY they want it returned? It is legal for them to request it back if they paid it incorrectly.
Why do they want the money back?
They usually can do this if they determine that they paid your claim by mistake.
What reason did they give for wanting the money back?
I don't know if this is okay or not, but I'm sure interested in the responses you get because I have Blue Cross insurance also and am supposed to go for some lab work. Now I'm going to make sure I go to a lab that is contracted with them.
Thanks for the heads-up; I really hope you get this resolved to your satisfaction!
I have a good friend that just went through this same thing...with totals over $3,000 I believe. They did end up having to pay it - I remember thinking it was obnoxiously unfair when she told me - talk about wrong! I can't think of too many things more messed up in this country than health insurance :/. Because they were so diligent about trying to pay it back and working with the doctor's office...the doctor's office ended up forgiving a good chunk of it.
Call the insurance to find out why they reprocessed and reversed the claim decision. It could be deductible, eligibility, other insurance coverage, diagnosis/coding, many things. Find out what they need to reprocess and pay it.
They are allowed up to a year to take the money back. Beyond that you have not given enough information to answer your question.
I work in accounting in a billing office, this happens every day they are well within their legal rights to take the money back.
You are the only one who can straighten this out. Call your insurance company!
Whoa! You need to HOUND them to find the checks you signed over to them. I didn't have an exact experience but somewhat related. I had paid my anesthesiologist who then continued to say I didn't. I had a copy of the check that I faxed them and they conveniently found it. So please, please, please hound them. Do not get sucked into paying again. In the future, make copies of all checks...
If blue cross then if a statement of sole insurance was not signed that could be one reason. Another.could be the.coding, another you did not meet your deductible. Call ask for a appreciate right off. Ask for the entire reason it was paid and recollected. Do not pay any part except for the amount you feel you owe. Once you do pay the full amount to the doctor you lose an ally to help to get insurance to pay any amount they should. At the end you still may owe but hopefully not as much
I would tell them to contact the lab that you forwarded the checks to and good luck on them sending the money back.
Some claims adjuster obviously made a mistake and is trying to correct it and they paid when they shouldn't have. I would submit a complaint with Blue Cross depending on how far they take it.
