Refund request from humana

dorothysalyer@yahoo.com

New
Local Chapter Officer
Messages
4
Best answers
0
My provider saw a patient with Humana insurance in May of this year. I verified that the insurance was active at the date of service. We received payment from Humana. I have just received a refund request from Humana for that dos, stating that the member was not covered at time of service, because member did not pay their premium for that month. Are we liable to refund that money to Humana? or is it the members responsibility with Humana? Please help! Thanks
 

jlparker0898

Networker
Messages
38
Location
Lewiston, ME
Best answers
0
I would think refunding Humana and contacting patient for correct insurance information for DOS then billing the patient if no other insurance is found.
 

mitchellde

True Blue
Messages
13,309
Location
Columbia, MO
Best answers
0
Yes you must refund the money and then bill the patient. There is normally a grace period that goes into effect when the patient does not pay a premium and is considered "covered" during this grace period with the understanding that the premium will be paid in full and all past due paid before the grace period is expired. If this does not happen then all services that were "covered" after the last effective date of paid premium will be now considered non covered and refunds will be requested. This is something you cannot fight nor anticipate. It just is!
 

pamsbill

Guest
Messages
113
Best answers
0
I would make one exception to what is stated above. If you are not participating with the carrier then I would not refund the money, as you have no contractual obligation to do so. I usually at least write one letter to the carrier (even if participating) telling them the monies have been disbursed and they should look to their insured for the reimbursement -- as long as it does not go against anything in a contract which you have signed. Most contracts will have verbiage in them stating they have the right to recoup such payments so always check your contract.
 

mitchellde

True Blue
Messages
13,309
Location
Columbia, MO
Best answers
0
You need to check state law also, most states have a state law that participating or not if the carrier requests the refund within a specified time frame (usually 18 months) then it must be refunded.
 
Top