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What to do with Insurance overpayment?

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BalancedLiving:

--- Quote from: DMK on December 19, 2011, 09:40:12 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.

--- End quote ---

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:

--- Quote ---. Would you normally not even bill to "see if they'll pay" if it's suspected that the benefits max has been met?
--- End quote ---

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. 

Michele:
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!)

DMK:

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.

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