insurance payment "recovery"

[leslie mar]

Hello -
we just had an insurance company "recover" money for an "overpayment".  they did this by subtracting the amount out of another claim.  Date of service of the "overpayment" is 1/19/07.  Understanding that overpayments (as well as underpayments) happen...can an insurance company "recover" an amount, what is the process and if so can they come back 18 months later with no further justification other than "we overpaid"?

[Michele]

Unfortunately they can "recover overpayments" from current claims which can be a bookkeeping nightmare.  However, they do need to give you a reason for the retraction of funds.  If it is not on the eob, (which it is not always!) then you should call to find out. 

Michele

[leslie mar]

thanks for the response - is there any time limit or is this "just whenever".  18 months seems to be on the outside of resonable...

[Michele]

Laws vary from state to state, but in our experience 18 months is not uncommon.  The insurance carriers do internal audits anywhere from 6 months to 2 yrs or older.  We have seen claims older than 18 months retracted stating they weren't the primary carrier, making it difficult to go back and bill the primary carrier.  (The patient had failed to inform the provider of his primary insurance and it was MULTIPLE visits.)  We were able to get them to pay with proof of the not so timely retraction.

I wish I had a more pleasant answer for you.  

Michele