Wiki Insurance payer requesting a refund

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JAMETH345

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Do insurance companies have a time limit in which they can request a refund? If there isn't a legal limit, could an insurance company demand a refund of a payment they made 10, 15, 20 years ago?

Thank you.


John Methgen, CPC-A, CPB
 
It depends on the state and the reason for the refund request. If it is a coding error on the part of the physician office then generally there is no time limit. If this is something they paid in error then generally there are limits and it varies from state to state.
 
I agree with Debra, for TN if it is the insurance companies mistake then they can only recoup within 18 months, if it is provider error then the time limit does not apply.
 
BCBS recoup from 2013!

I am in need of some guidance regarding a recoup recovery from BCBS (in Texas).

We billed BCBS on 01/11/2013 for 4 bilateral codes (30140, 31255, 31296, 31256) and BCBS paid in 2013.
Now in 10/2017 they have recoup'd indicating that they overpaid on the last 3 secondary codes (cutting each by another 50%).

What are the rules/regulations regarding recoupment in regards to timeframes and reasoning?

Any help is very appreciated!
 
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