Wiki Insurance refund request Covid billing

[prhodes66]

Ok just got this refund request from major payor -- we are Non Par provider for this carrier . This is for Covid testing - done from July 2020 - to Jan 2021- Insurance requesting refund due to they paid charges at 100% of charged rate Insurance states due to Care Act section 3202 - Insurance should of paid our Self pay price -- as listed on website - Our prices are not listed on our website. Our office charges same price to all insurance carries and also same price to self pay patient - except we offer a prompt payment discount - if paid at the time of service. Insurance company states that per Covid Cares Act -- they should receive the same prompt payment discount . Should I just refund this or should I try to appeal overpayment - stating we charge all insurance and self pay same price If they can pay at the time of service and write my check payment on the same date they can get the same discount .

 

[thomas7331]

How much money is being requested? The amount of money at stake here should determine the amount of resources you put into determining how and whether to dispute this. I would not just refund the money without at least putting up some resistance. At the very least, you can write a simple letter explaining to the payer just what you've posted here and see what they say - there's nothing to lose and not a lot of resources involved in just challenging this at face value. If the insurance company pushes back, and if the amount they're requesting involve a significant financial impact to your practice, then you may want to consider disputing this more formally, e.g. involving an attorney or legal representative if necessary.