The law requires health insurance companies to return insurance overpayments promptly. If you or a patient received an overpayment due to a policy change, you should notify your payer right away. This can be done by offering to apply the money to the next visit, or sending a check. You must explain why you received the overpayment.
Generally, insurance companies notify their agents if they receive an overpayment refund or a takeback. Once they receive your request, they must determine where they should refund the money. Insurance overpayments are usually posted to an Insurance Overpayment holding account or against a family account charge. The company will use your EOB, as well as their own records, to determine where the money is supposed to be.
In some cases, your payer may refuse to give you a refund for an overpayment. This happens when you have more than one insurance policy, or you have a secondary plan that pays a higher amount. In these cases, you can appeal to the payer to get the refund. The reimbursement amount may be higher than what you owe, but the payer may not see it as an overpayment.
When a patient receives an insurance overpayment, it’s important to follow up. Make sure your payer has reprocessed the claim to reflect the correct amount. If you’re unsure, ask your provider to return the overpayment or to credit it to future charges, if you’ve received it by mistake.
If the insurer is unable to refund the money, you may have to file a request for reimbursement. If the payment was made in error, there could be a clerical error or the insurer has changed their mind about the service after you’ve paid for it. Other factors that can affect whether you are eligible for a refund include fraud and the time since the payment was made.
Some reasons for overpayments include incorrect provider names. Usually, carriers will contact the patient after discovering the error and reprocess the claim with the proper benefit. Sometimes, the overpayment amount is deducted from future benefits due to the same patient. This practice is not considered fair by many members. Dental professionals believe that the carrier should cite state law or regulatory authority for this practice. They believe that the carrier should include this information in the policy.