Wiki Help!!! Overpayment letter from Humana

[Rindahlnicole]

Hello! We billed Humana for a patient for 9 visits total from 12/19/2013-06/13/2014. We were paid on all visits and then over 6 months later get a letter stating that they overpaid because the coordination of benefits are wrong. They state that they are not the primary insurance. The patient has called Humana and told them to change his coordination of benefits as he has never had this insurance (which I double checked, the "primary" insurance has never had him under their coverage). I called to double check that the coordination of benefits have been changed so I could get the refund request removed. One lady told me he had and they were just waiting on the financial recovery center to double check with the other insurance. They transferred me to that section of Humana which told me that it wasn't their responsibility and the COB has not been changed. Then they transferred me back to another lady who told me a whole other thing. Basically they are saying the patient needs to call again and do it all over again because it wasn't updated, even though he already has. PLEASE HELP!! What can I do to get this resolved as now I am having trouble getting a hold of the patient! Sorry for the lengthy explanation.

 

[letitiadickerson@yahoo.com]

COB issue

Hey
The patient would have to be billed and eventually if he does not pay send him to collections. The problem with COB issues are the responsibility of the patient and not the doctors office. Remember this is the patient's insurance plan who chose for himself. If he has another insurance then he will have to contact both of the insurance companies to get a letter of credible coverage and it will show the effective date and the expiration date of the primary and or secondary and then he would contact Humana to show credible coverage dates so that he will have a letter in hand to appeal Humana's decision if he truly does not have another insurance. If humana recouped money for COB did you resend the 9 claims to the other insurance company to get a response? If the other insurance states that he does not have coverage use that denial letter to appeal Humana

Hope this helps..We have COB issues all the time at my office and truly the patient needs to get this straight with both parties!!!