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Insurance is requesting money back | What to do?

Patient was in two car accidents and the car insurance paid out of the wrong account. The patient had no PIP coverage. They are now requesting money back.

My question is: Do I have to return money back when it was their error. It is too late to bill the patients private insurance.

We provided the services and were paid. I don't feel that I should have to return this money and be at a loss.



Well, the insurance company does not really have a “claim” against you. As you outlined, they paid for services already rendered. It was their own mistake by not realizing that there was no coverage.

Some states will look to see how close the payment was issued to the provider to the date the insurance company asked for a refund. If the payment is close (i.e, same day or within a reasonable time – usually shorter periods of time), then those states will request that you return the payment.

Also, it depends on what kind of agreement you have with this particular carrier. If you have an agreement (an insurance/provider agreement), then the terms of such agreement would control.

If there is no agreement, then the insurance company would probably have to go against their own insured and try to recover from them for their mistake.

I hope this helps,

Good Luck,

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