Question Retroactive Insurance And Refunds

Messages
1
Location
Salem, OR
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0
We have a received a refund request from our local BCBS plan for services rendered between September and December 2020. For 2021, the patient enrolled on their parent's Kaiser plan in addition to BCBS. We did not discover this until we were checking eligibility for 2021 and noticed the secondary plan, Medicaid, terminated at the end of October. The family ever notified us that Medicaid had terminated, nor did they notify us that they would have Kaiser until we called them in January asking if they had any other insurance then BCBS. When I spoke to the family in January, Mom said they now had Kaiser, but did not have the member ID or any other information for us. Kaiser requires a referral and we had already seen them for one visit in the new year when I spoke with her, so we let them know we would have to cancel their upcoming appointments until she spoke with her PCP to send the referral. That never happened...

Apparently the Kaiser plan was retro-effective to July AND is the primary insurance, so BCBS wants us to refund them over $2,000, resubmit the claims to Kaiser, and then send in an updated claim. I really don't want to do this because I feel it's a waste of my staff's time, and the insurance information was correct at the time services were rendered.

Are we obligated to do this? I read through our contract for both insurances and this is not mentioned. I'll be contesting the refund regardless, but just wondering what you have done.
 

sls314

Guru
Local Chapter Officer
Messages
161
Location
Toledo, OH
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0
In a short answer: Yes, you're obligated to do this. Especially since these claims are less than a year old.

Bill Kaiser with the information about the recoupment/refund given to BCBS. If/when Kaiser denies, rebill BCBS as secondary.

Unfortunately, these situations happen, and we're left with extra work to do. It stinks, but we still have to do it.
 
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