Wiki Overpayments

[amym]

I have a patient that has 3 insurances on file MCR, BCBS and AARP. BCBS pays only 50% of Medicare's 20% co-ins and AARP picks up the full 20%, even after the secondary paid. We were advised that AARP does not coordinate benefits with BCBS and any overpayments must be sent to the patient. Has anyone heard about this? I am scared to send the patient overage and later on for AARP to come back and ask for their money back.

 

[Tracey Thompson]

Yes, I encountered this several times at a previous office, but I believe it was with Aetna. In order to comply with the insurance company and provide coverage for yourself, my advice would be to do the following:

1- Get a document in writing from the AARP (or other insurance company as applicable) stating that they do not COB and that any overpayments resulting from lack of COB are to be forwarded to the patient. Keep this document on file.

2- When you send the overpayment to the patient, have a standardized letter attached explaining the situation. Also, inform the patient within this letter that if for any reason the insurance determines later that the overpayment was not due, the patient is responsible for repaying.

3- Keep meticulous documentation of all actions taken including the documentation from AARP and copies of all correspondence with the patient.

I know this seems like a lot of work to only return money to a patient. In my experience I have found that all of these steps are necessary and provide documentation for your actions.

Hope this helps!