Wiki Overpayment/Refund

[karriedemas@yahoo.com]

I have a situation where a patient has Medicare and Aetna - both paid as primary insurance. I called Medicare and they said they paid correctly, then I called Aetna, and they stated that Aetna is primary because of employment. Not sure what my next step is to refund the correct insurance and to get my claim paid correctly. Any suggestions???

 

[AprilSueMadison]

http://www.medicare.gov/Pubs/pdf/02179.pdf

The above is really helpful.

Unfortunately, we are never able to correct the problem for our patients. You'll likely have to contact your patient and explain that Medicare or Aetna is paying incorrectly and they need to get it corrected. Post the funds and then hold them until the patient calls you back to tell you it is corrected. Then we contact the insurance that paid wrong refund them.

 

[karriedemas@yahoo.com]

That is helpful - Thank you!!

 

[fnk001]

overpayment/refund

I have been in the same dilemma. I had to call the patient and request them to update their coordination of benefits with both carries and once the patient has done that, I check with the carries to make it was updated and go from there in having the over payment refunded. It is a long process, because sometimes I get patients who take care of it right away and others I have to call more than once to remind them to update the information.

 

[MarcusM]

And it is better to get this done sooner rather than later as at some point, Medicare will recoup funds. I had one case with two primary insurance plans and a secondary as well, and it took months to get it sorted out.