Question
What is the name of your state? Oregon
I work in a tiny clinic in Portland. An insurance company recently requested a refund for what they believed to be an overpayment for patient services. Our records did not show this as overpayment. This company said that they would deduct the amount from a future dispersement check if we did not send in the refund.
My question is: Is this legal? I thought that federal law prevented this type of withholding, and that we are not to be held responsible for their bookkeeping mistake. Is this true?
Laura
Answer
If there was a mistake, you have to pay the money back.
Answer
I guess that's the question. Our records do not show an overpayment. How do we know this is correct?
Answer
Are you an in-network physician with this insurance carrier? The answer will make a difference to the rest of the response.
Answer
If you are contracted with the carrier, your contract will most definitely stipulate that you must pay them back if they discover an overpayment; however, if you should still send a letter to them and make them prove to you that they overpaid you and demand that they cease future recoupements until your appeal is received and researched. (In Texas, the law states they must not recoup until after an appeal is submitted.) Your appeal letter should also furnish any evidence on your part why you don't feel you were overpaid. I have yet to lose any of these types of appeals except where the patient's coverage had terminated.