Sally had back surgery. Her insurance company overpaid her surgeon. How could this be Sally’s problem?
Sally’s surgeon was out of network. Since she was out of network, the insurance company paid Sally directly. Sally, in turn, endorsed the check over to her surgeon.
Two months later, the insurance company sent a letter to Sally stating that they had overpaid the surgeon and the insurance company wanted Sally to pay the insurance company back for the $6,500 overpayment. Sally thought this was absurd. How could she possibly know that the surgeon was overpaid? Sally asked me what to do.
First, before you endorse a check over to your doctor, always make a copy of the check and get a receipt. Luckily, Sally had a copy and a receipt.
Second, start with your surgeon’s office. Every office has a billing department. Explain the problem. Show the office the insurance company letter and ask them to reimburse the insurance plan.
Third, if the surgeon’s office won’t help, contact the compliance office at the insurance company. You should make sure you put everything in writing so you can show the insurance company that you attempted to get the surgeon’s office to return the money.
You might be surprised to know that overpayments happen about 20 percent of the time. This is due to coding errors or the insurance company processing payments for services that are not covered by the health plan.
Have you ever received an overpayment from your insurance company? I’d love to hear from you!
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