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Patient did not disclose that they had insurance

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PsychBiller:

Happy New Year to everyone!

A patient of ours did not disclose that they had Aetna insurance, paid the full amount for services, and then filed their own claims with insurance.  Months later they produced their insurance information and asked for us to submit claims going forward.

Now they are demanding that they be reimbursed for those visits where they paid the full price (basically wanting the difference between what was allowed by insurance and what they paid), and are claiming that we have committed insurance fraud.

Do I need to reimburse them?

Sriram_Sub:
If you have a patient registration form that did not state any insurance info disclosed by the patient, that document along with the receipt for full payment made by patient stand as a proof that there was no insurance fraud committed by you.

Aetna's Timely filing limit (as you may be knowing) is 90 days. If there is still time, please confirm eligibility and try submitting it to the payer. Upon receipt of payment from Aetna, you may decide on refunding to the patient. If the TFL is already lost, the patient has no right to claim it from your office.

Michele:
Sriram_SUb is correct.  Also, if they already submitted the claims and received payment directly they cannot expect you to give them their money back.

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