Question
What is the name of your state? New York
United Healthcare did an audit from 1999. They're saying benefits they sent me to pay ER doctors were supposed to have been paid by Blue Cross -Blue Shields payment to the hospital. They want to reduce my future benefits by $425. for one and $528. for the other until they get it back. I have the cancelled checks I sent to these doctors. Am I responsible for their billing errors from 5 years ago?I did what I was supposed to do. Since the ER doctors are not in our plan they are covered 100%. United Healthcare sends me the money, when I get the bill I paid the doctors. Now they're saying some hospitals have contracts with BlueCross to have ER Doctors paid from their payment for the hospital. It was so long ago these doctors have different billers now. Is it really reasonable for United Healthcare to think I can get a refund from these doctors and ask them to re-submit the claim to the hospital?They don't care -they're just going to take the money from me! Isn't there a statute of limitations for this kind of thing?
Answer
They did an audit now for 1999?
The first thing you need to do is get your hands on a copy of the insurance contract/Plan Document and see what it says regarding clerical errors/mispayments and how far back they can go. (I can tell you that two years is typically the maximum length of time an insurerer will accept an outanding medical bill - if it's older than that, they'll tell you the records have been "purged" and are no longer available, thus they have no idea whether the bill may have been previously paid.)
I suggest you also contact your State's Insurance Commission and run your situation by them and see what they say.