Medical Billing Forum

Payments => Insurance Payments => Topic started by: barb2512 on October 02, 2015, 12:25:56 PM

Title: Insurance Company Retroactive Cancellation
Post by: barb2512 on October 02, 2015, 12:25:56 PM
I am familiar with an insurance companies asking for refunds because the client's policy terminated and some claims were paid anyway.

But has anyone held the sponsor of the plan, the employer, responsible for the services rendered when the employer did the retro-cancellation 5 months later and the client has been seen for 18 visits.

Thank you.
Barbara :(
Title: Re: Insurance Company Retroactive Cancellation
Post by: Michele on October 03, 2015, 08:22:20 PM
No but that isn't a bad idea!  Honestly I don't think that you can but I'd love to hear from anyone who does know the legal answer to this.  It does seem unfair when a patient is seen, the claim is submitted and paid, and then months later they ask for a refund.  It's very difficult to get the patient to pay.  Unfortunately the patient should ultimately know if they no longer have coverage when they see a provider.
Title: Re: Insurance Company Retroactive Cancellation
Post by: Ypmb16 on January 23, 2017, 06:21:11 PM
It is ILLEGAL for an insurance company to retroactively cancel an insurance plan. They have 30 days.
Title: Re: Insurance Company Retroactive Cancellation
Post by: PMRNC on January 25, 2017, 05:23:24 PM
Quote
am familiar with an insurance companies asking for refunds because the client's policy terminated and some claims were paid anyway.

But has anyone held the sponsor of the plan, the employer, responsible for the services rendered when the employer did the retro-cancellation 5 months later and the client has been seen for 18 visits.

Are these for ERISA policy's? if so yes, there is recourse for appeals the PATIENT can do. A provider can do an appeal as long as the patient has given consent for them to do so.

Title: Re: Insurance Company Retroactive Cancellation
Post by: PMRNC on January 25, 2017, 05:24:58 PM
Quote
It is ILLEGAL for an insurance company to retroactively cancel an insurance plan. They have 30 days.

That is a blanket statement.. if a policy holder terminates a plan can retroactively collect back money paid for claims within that period. The question is.. if they are ERISA claims the patient is responsible for providing a refund to the payer, NOT the provider.