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Wiki Bcbs refund recovery

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jennaduncan

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Atlanta, GA
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Our office has received a refund recovery request for BCBS Federal. We verified the patients insurance at the time of service. He had Tricare and BCBS, and we verified that BCBS is primary. After discussing this w/ the patient he told me that he didn't understand why he had to use BCBS because that was his Ex-wife's insurance and that had been divorced for years, she just never took him off her plan. That was February 2012. On June 30th we got the refund request stating his coverage terminated 4/1/2010. Can they legally do this? He was not able to use his TRICARE because the BCBS was primary. They are asking for close to 5,000.
 
Yes, this is legal. Being divorced means he can not be covered under her health plan in most instances (many plans recognize significant others living together, etc, but I don't know for sure about the Federal Employee Health Benefits). In any case, it appears that after you spoke with the patient, either he or his ex-wife called and had him removed from her insurance back to when the divorce was final. Since he was not covered, they can definitely request a refund for any moneys paid incorrectly.

You should be able to file to TriCare with a copy of the BCBS denial.
 
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