Author Topic: What to do with Insurance overpayment?  (Read 2318 times)

BalancedLiving

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What to do with Insurance overpayment?
« on: December 19, 2011, 02:08:35 PM »
I am currently billing insurance companies for my husband's new chiropractic office. I am very careful and thorough, as I am scared of making mistakes that could cost us. Aetna recently paid on visits for a patient who had reached his yearly benefit max for Chiropractic. (They paid $82.50 over his plan benefits) At first I thought there was no harm in billing and seeing if they'd pay, as maybe our visit numbers were not accurate, due to him seeing another doc previous to care in our office.  Now I'm wondering if this could get me in trouble? Do I need to send this back to them somehow? Advice would be appreciated!

BalancedLiving

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Re: What to do with Insurance overpayment?
« Reply #1 on: December 19, 2011, 05:58:15 PM »
Are insurance overpayments really that unusual? 8 reads and no replies. Hmm. Just wondering if insurance companies state anywhere what the protocol is for overpayments? No one knows?

PMRNC

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Re: What to do with Insurance overpayment?
« Reply #2 on: December 19, 2011, 06:13:28 PM »
The carriers have their own protocol's but ultimately if you know they overpaid the correct and legal responsibility is to return the payment with explanation, if not they can recoup for the time limit allowed (state laws on this now)   Some carriers will process the future claims and deduct the overpayment there and some will just request it.
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DMK

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Re: What to do with Insurance overpayment?
« Reply #3 on: December 19, 2011, 06:40:12 PM »
I hesitated to respond to this because each carrier is going to handle it differently. 

With Aetna, my experience has been that they don't include exam codes in the chiropractic $ amount allowed.  That may explain some of it. 

Medicare, don't mess with, send it back.

Blue Cross will find it, so beat them to it.

Always re-pay W/C.

The best advice I've seen is to call!  They'll let you know if it was correctly paid.

BalancedLiving

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Re: What to do with Insurance overpayment?
« Reply #4 on: December 19, 2011, 06:40:45 PM »
Thankyou PMRNC! I'll just contact them and ask how to send it back then. Would you normally not even bill to "see if they'll pay" if it's suspected that the benefits max has been met?

BalancedLiving

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Re: What to do with Insurance overpayment?
« Reply #5 on: December 19, 2011, 06:44:34 PM »
I hesitated to respond to this because each carrier is going to handle it differently. 

With Aetna, my experience has been that they don't include exam codes in the chiropractic $ amount allowed.  That may explain some of it. 

Medicare, don't mess with, send it back.

Blue Cross will find it, so beat them to it.

Always re-pay W/C.

The best advice I've seen is to call!  They'll let you know if it was correctly paid.

Ah, it was Aetna, so the exam thing makes sense...although they seemed to have paid for 2 visits too many.....I'll call them.

PMRNC

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Re: What to do with Insurance overpayment?
« Reply #6 on: December 19, 2011, 07:21:04 PM »
Quote
. Would you normally not even bill to "see if they'll pay" if it's suspected that the benefits max has been met?

I sort of avoided this question intentionally.. because there is a "grey line"  I'd have to say "no", as long as services were rendered and you are not double dipping.. HOWEVER.. if there max was met, you should check the calendar year of the plan (it's not always Jan-Dec), and let patient know and bill them the out of pocket and leave the "I'll fill it just to see if they pay" to them. 
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Michele

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Re: What to do with Insurance overpayment?
« Reply #7 on: December 20, 2011, 07:14:29 AM »
I wouldn't bill to "see if they will pay" but I would bill for the denial.  They may have a flex account, or some other account, plus the credit to the out of pocket, etc.  Many of our providers want the denial.  You aren't doing anything wrong in billing it.  They are supposed to deny.  If they pay in error, you need to be prepared to return the overpayment but you aren't doing anything wrong.  :)

For the billing services out there, this is a great argument against % billing.  In the above case, you get nothing!  :(  But you spent the time, and the dr gets paid because the patient pays them.  (unless you are doing patient billing too, then you get paid, but you get the point!)
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DMK

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Re: What to do with Insurance overpayment?
« Reply #8 on: December 20, 2011, 10:45:46 AM »

Ah, it was Aetna, so the exam thing makes sense...although they seemed to have paid for 2 visits too many.....I'll call them.
[/quote]

Bear in mind that Aetna's  Chiropractic $ amount for the year is their "allowed amount" not the billed amount.  So if you billed $47 for a 98940, and their allowed amount is $31.20, only the $31.20 goes toward their Chiropractic $ maximum paid.