appealing a refund request

la_0922

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Has anyone successfully appealed a recoupment? For example, Humana is recouping 1/2 of their original payment because they misprocessed it based on the multiple surgery rule. But I have had a consultant tell us that "courts have generally ruled that insurance companies may not be entitled to refund payments that result from a mistake made by the insurer. Contrarily, legal statutes stipulate that healthcare providers are innocent parties and that the party who created the loss must incur it." is it worth spinning our wheels?
any input or stories of victories would help :)

thanks,
Louise CPC
 

swilliams2

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Jacksonville FL
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refund

Not sure this is a place I would want to go. If you billed multiple procedures and the claim SHOULD have paid at a discounted rate becasue of the rule, why wouldn't you want to refund the claim? I would fight something that is being processed incorrectly, but not something that is being processed correctly.
 
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