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Refunding Carriers
midwifebiller:
Michael
You're referring to the court case of City of Hope Medical Center v. Superior Court of Los Angeles County (1992). We have referred to this case in our letters to BC and BS of CA (since they seem to want money back frequently), but have not had good results. I would like to see your refusal letter, if you don't mind, to see what we might be missing.
Thank you!
~Kelli
kelli.sugihara@midwifebilling.com
oneround:
We also have the same issue with BC BS. because everything is done EFT they constantly retract and we don't catch it until it show on our AR we have to appeal. With our HMO and PPO plans for BC BS it is written in our contract that they cannot take payment back if they pd in error after 365 days. With ERISA plans it's the city of hope clause. I cannot show our contract verbaige but I do have some legal references for you. www.ahcinc.com is a good source. Lawrence Reid, ESQ. is a great Attorney that deals with refund laws. He wrote an article titled 'Dealing with refund demands. Problem with this carrier is that even with the clause and our contract they still try to retract. We have to spend the extra manpower to appeal but we usually win.
Pay_My_Claims:
They do what they do because they can..........
midwifebiller:
Thank you again, Michael. It's somewhat comforting to know that other providers have similar problems with the carriers. The weblink you shared has quite a bit of helpful information!
~Kelli
Anand:
--- Quote from: oneround on December 30, 2009, 02:41:38 PM ---There have been many comments on what constitutes a provider having to pay back a payer when they request payback of an overpayment. Each state has different regulations. Some states have no regulations that prevent a provider from having to pay back a payer. I received this link from a peer and would like to pass it on to those of you that could use it as a reference tool.
http://www.mtbc.com/legal%20corner/Insurance%20Refund%20Recoupment%20LAWS.pdf
--- End quote ---
Hello - any ideas when this rule was applied? Is thier any changes in the rule for 2010? Thanks
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