Author Topic: In trouble again?  (Read 907 times)

ste

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In trouble again?
« on: October 15, 2010, 10:51:42 PM »
Are there any circumstances which would cause the following?
A provider bills a patient's insurance and the insurance sends the provider an EOB along with a payment which is consistent with the EOB. Then the insurance sends a bill to the patient in an attempt to recoup some or all of the money paid to the provider.

The only thing that comes to my mind is perhaps the patient was carrying an insurance card under false pretenses.

PMRNC

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Re: In trouble again?
« Reply #1 on: October 16, 2010, 01:14:54 PM »
There are other scenario's, the patient could have been on COBRA and the carrier had not updated allowing time for the premium to come in..when it didn't it is allowed to retroactive the term date, another situation could be due to EOI investigations to which the patient did not disclose a condition on their EOI and the coverage was "rescinded"
There's also a slight possibility the claim was paid to the insured because the carrier missed the AOB and then they reprocessed and requested refund from patient.

I wouldn't worry about it for now unless they come to you for payment back.
Linda Walker
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