Medical Billing Forum
Billing => Billing => : billinggirl January 04, 2012, 03:25:53 PM
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Question: I have a patient that we provided services for and the insurance company sent a check to the patient and then sent a check to us. Now the insurance is requesting a refund from us. Who is responsible for refunding the insurance monies? Are we (the provider, or) is the patient reponsible.
If the patient signed an Assignment of Benefits form, wouldn't the patient be responsible for refunding the money back to the insurance?
Thanks
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When the claim was filed, did you check Yes to assignment of benefits on the claim? If this was checked then the insurance company should have mailed the check to you.
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the insurance sent us a payment also and now they want a refund from us.
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Whoever got the 2nd payment will have to refund the money. If the patient got a check dated before your check, they should have paid the doctor, so the check the doctor got was an overpayment. (I understand EVEN if the Assignment of Benefits was signed, the insurance company screwed up, but they won't look at it that way.) If you got the check first, then the patient will have to return the money to the insurance company, and good luck with that. (It's wrong, but that's the way it is, most of the time the patients won't do what's right.) The insurance company KNOWS that they will get the money from the doctor some way some how, they may not ever get it from the patient.
But BE SURE to bill the patient for what they owe. And attach a letter showing that you are aware that they received the funds from the insurance company.
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Thank you for your help.....
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Do you participate with the insurance carrier? If you participate it is usually one of the stipulations in the contract that they pay the provider directly. If that is the case they should be going after the patient. We have had insurance carriers that have had to go back and request money from the patient because they paid them in error and the provider was par.