Wiki Insurance recoupment


Best answers

I have a question. The billing company I work for is out of Utah but the Dr. I work for his clinic & surgical center resides out of Nevada and I see that State Regulations Regarding Recoupments show that Nevada "NO STATUE EXISTS" & under "TIME LIMIT FOR SEEKING REFUND OF OVER PAID CLAIM" shows "NONE".

I also see in another thread someone is saying, State laws that regulate this only apply to fully insured plans. Also, that patients covered under large group policies that are self-funded by their employers are not subject to state regulations.

My question is we are Out of Network on a majority of our claims. Does this apply to us? My boss wants me to do a letter to dispute the refund recoupments stating that there is a time limit of 12 months to 24 months. Also, If there is no "State" statue like Nevada does Federal law apply? Since Federal Law applies to ERISA plans? If so does anyone know how I find out Federal recoupment law for the state of Nevada?

Also, we have our patients sign a Assignment of Benefits/ERISA Authorized Representative Form with our patient packet allowing us to appeal or dispute on their behalf. We send in our claim & more than not we always have to appeal for payment. We then send in our appeal on a claim & the insurance company comes back stating we cannot appeal on the patients behalf w/out a Designation Authorized Representative Form. Then I mail out our "Assignment of Benefits/ERISA Authorized Representative Form. Then we will get back from the insurance company mainly BCBS, UHC & UMR at this point and they want their own Designation of Authorization form filled out by the patient. Then I will send a authorization form to the patient from there particular insurance company have patient sign & return to us. Then I mail off again along w/the insurance companies letter requesting the authorization and also another copy of our appeal as they requested. Then they come back again stating that the authorization form is not the one for this particular division of BCBS, UHC??? Really the wording is the same & one plan may be BCBS Federal & another out of Illinois. So frustrating. Can anyone tell me if this is legal? Are the insurance companies suppose to legally take our Assignment of Benefits/ERISA Authorized Representative Form as long as all the legal information is on our "Assignment of Benefits/ERISA Authorized Representative Form" is correct? Someone please help:/ SORRY FOR SO MANY QUESTIONS!
Last edited by kell0870; 07-27-2017 at 11:57 AM.