Wiki Insurance refunds - time limit by state

[sbrown8]

Hi! I need some help with an issue in my office. Can anyone help me with how time limits by state statutes work in regards to insurance company refund requests?

I work in a Florida based independent lab which collects samples from around the country. Since we are a Florida provider who performs the service in Florida we have always followed the 30 month time limit that insurance payors have in which to ask for a refund.

Recently a co-worker has said that this is incorrect and that we have to follow the statues of the state in which the patients home plan is located for Blue Cross insured patients or the state in which the patient lives for all other payers.

I have tried researching this myself and can find the statutes by state but not how they are applied. I have found nothing to support my co-worker's theory but neither have I been able to find in hard fact that we are to follow Florida statutes.

Any help with this would be greatly appreciated. Thanks in advance!

 

[lorrpb]

The law is one that applies to insurance plans, not providers. Therefore, the insurance plans are subject to the laws of the state in which they are licensed, not the laws of state in which a provider is located, which is what you are suggesting. The flaw in the reasoning is not that "you" are required to follow Florida laws because you operate in FL because it is not "you" who has to follow this rule. (Of course, you must follow the FL laws written for providers.) Rather, it is the insurance company that has to follow the laws in the state(s) where they are licensed/operate and the time limit law applies to what insurance companies must do, not what "you" the provider must do. I hope that makes sense. That would be the legal rationale, although I cannot cite a reference off the top of my head.

Now if you, as a provider, have a national contract with an insurance company, both you and the insurance company must adhere to the terms of your contract, which most likely has a timely filing clause, etc.

You could try contacting the FL Department of Insurance and ask them if insurance plans licensed in other states have to follow FL laws when dealing with your company. It may take some digging to find the right person who can (1) understand the question, and (2) provide an accurate answer.