Refund Request Letter
Steve,Awhile back, you posted a letter to be sent to the insurance co who is requesting a refund. I have been looking around and I cannot find it, maybe it was one of those post that was deleted when...
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OK, but I need to know:1) Is the doctor contracted.2) Why are they demanding the refund.3) What is the date of service and date of payment.
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There is no specific incident, I just recall reading one awhile back. I could use it for future request. I know about the questions you are asking and I will make sure that I consider them before...
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Since I wrote that letter, I have made changes to the way I handle a refund request. This is because of what I learned about ERISA and contracting.If I am not contracted, I deny their request and tell...
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I am a contracted provider with your company. Per the terms of our agreement, I verified benefits prior to submitting my claim. The claim was submitted in a timely manner. I accepted assignment for...
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I am in receipt of a demand for an alleged overpayment your company says it made to me in regards to medical care that I provided to your member (name of patient) on (date of service.) As you are...
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Hi Steve, First I can't thank you enough for this information - a prospective provider just asked me about this type of situation on Friday and it will certainly help me to have some information to...
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You stated your doctor is contracted. What does the contract say about claims for overpayment. I'll bet it has no times for when the insurance company can go back and perform retroactive reviews. I'll...
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Thanks very much Steve, I am also in Florida so the 12 months for eligibility would apply here but I doubt they replied in writing to the recoup within 35 days. I faxed the office manager over your...
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Most of the major insurances here in Florida have the same clauses in their contracts, which is, if the carrier peforms a retroactive review, then the provider gives an implied consent to offset what...
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Thanks again Steve, This specifically says Health Maintenance Organization, but does this all apply to a PPO as well? Also, with regard to the following 2 excerpts:3. The health maintenance...
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This also applies to PPOs, POSs, and IPAs. The wording in FS 641.3155 is identical to FS 627.6131. That is your commercial insurance law.#3 is in accordance with the 35 day rule. If they send a claim...
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OK, thanks Steve, because I am almost positive that these take-backs were as a result of the insurance company finding after TWO YEARS that these patients weren't eligible. So, if I am understanding...
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let me add - IF it is 2 years after the date of payment and not dos.
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The law is specific on the timeframes, however, it's what is in the contract that is most important. If the provider agreed to automatic takebacks, it doesn't matter what the law says. If the contract...
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Wow = thanks Steve, this is great. I will give them a copy and see where it goes. Thanks so much again...Robin
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Thank you for all of the information. I am in the middle of a refund request in a non-contract situation. Do you recommend taking care of this in writing only, or would simply call and state that we...
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Another follow up question. Are you aware of any special provisions in the state of Wisconsin that I need to be aware of? Thank you.
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Cyndi you would be better off starting a new topic for your specific questions.
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