Wiki Automatic Recoupment Without Notification

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An insurance company automatically recouped payment without notifying us.
They admitted that they were at fault for not sending an overpayment recovery letter and thus giving us time to appeal the decision. Do they have to refund us the money because they did not send a letter?
 
I'd review the terms of your payor contract. There should be a section that deals specifically with recoupments - what the payor's contractual obligations are and what the provider's contractual obligations are.

However, personally, I'd focus on the reason for the overpayment and if I could successfully dispute that it was an overpayment. Then I'd use that as additional justification to get the claim repaid.

Do you disagree that there was an overpayment? Submit what you'd normally submit to appeal the overpayment notice and that will give you a stronger argument to get the money back.

IMO, I'd rather not waste time arguing with them to give it back, then just turn around & appeal it. I'd appeal it successfully then demand repayment with interest.
 
I'd review the terms of your payor contract. There should be a section that deals specifically with recoupments - what the payor's contractual obligations are and what the provider's contractual obligations are.

However, personally, I'd focus on the reason for the overpayment and if I could successfully dispute that it was an overpayment. Then I'd use that as additional justification to get the claim repaid.

Do you disagree that there was an overpayment? Submit what you'd normally submit to appeal the overpayment notice and that will give you a stronger argument to get the money back.

IMO, I'd rather not waste time arguing with them to give it back, then just turn around & appeal it. I'd appeal it successfully then demand repayment with interest.

I should add...assuming that this is not a persistent problem with the same payor.

If it was a persistent problem with the same payor and the recoupments were violating the payor contract, I'd be in contact with the provider rep demanding that they fix the process for recoupments to comply with the terms of our contract.

For a one time or sporadic thing, I'd just submit my documentation to appeal the overpayment. Then keep an eye out to see if they started pulling this same thing regularly.
 
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