Wiki patient vs. insurance refund

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ChristyP

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I do refund for the lab I work in. Recently we had a patient call and he has two anthem policies. One is a group plan one is a personal policy. There is no COB between the 2 policies so both end up paying as primary and the patient as well as anthem have told me the second payment needs to be forwarded to the patient. My supervisors however are telling me that we cannot send the payment to the patient we have to send it back to Anthem for audit reasons. Has anyone ever encountered a sitiation like this before?
 
We have always refunded the insurance company & not the patient. That has been our standard procedure, stating we received an overpayment from the insurance company & not the patient. If the patient feels they should receive payment then they would need to contact the insurance company directly. The solution might be that you only bill the primary insurance & the patient can bill the secondary so the payment will go to the patient. Hope this helps.:)
 
It is just a weird situation because Anthem confirmed that the money should go to the paitent but I think that in the future we will do as you suggested and only bill one of them and let him bill to the other.
 
I have the same problem. We alway refund the insurance company, never the patient. Also what would you do if you refunded the patient and then the insurance comes back and asks for the money back?
 
If the policy is purchased by the patient, and the plans do not have a COB, the refund is to be paid to the patient. I know it seems odd, but it's true. Trust what the payers are telling you.
 
mhadsell said:
If the policy is purchased by the patient, and the plans do not have a COB, the refund is to be paid to the patient. I know it seems odd, but it's true. Trust what the payers are telling you.
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I agree. We have encountered this type of situation before and the refund does go to the patient.

I hope this helps!
 
Agreed!

ChristyP said:
It is just a weird situation because Anthem confirmed that the money should go to the paitent but I think that in the future we will do as you suggested and only bill one of them and let him bill to the other.
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I've had insurance companies tell me to refund the patient and when we did, several months later that same insurance company came requesting that same refund back from us! I had to call them and give them the name of the person I talked to, date etc... told them I initiated the call and this is what I was told and I got a faxed confirmation of it as well. They told me the person who told me that was wrong, I told them it wasn't my problem anymore since I had that confirmation and all. They never contacted me back again after that.

I think if I were to do billing again at some point I would never refund a patient in this type of situation.

Just my two cents from experience :)
 
The refund should go back to the insurance & they refund the patient. I've encountered this problem before and since the payment did not come from the patient I could not issue a refund to the patient.
 
Refund

I agree with those who say refund the insurance. If the "over" payment came from the insurance, it should be returned to the insurance. If the patient is due a refund, then the patient needs to contact "his" insurance for the refund. I have also had situations where patients were refunded "insurance" overpayments and the insurance came back as much as three years later wanting their payment back. That situation is best left between the patient and his insurance. Just my 2 cents.:)
 
Insurance carriers not coordinating benefits between eachother, resulting in an overpayment to the provider is not uncommon. As the insurance carrier stated, the overpayment should be issued to the patient. However, cover yourself by obtaining a written document stating this from the insurance carrier. In the instance that the insurance carrier later requests the money back, appeal with the original letter received from them. If an appeal does not work and the insurance carrier ends up recouping the money, you would need to balance bill the patient. I know this seems like a lot and can be confusing. Just try to do what is legal and in the best interst of the patient while maintaining documentation to support your decisions.
 
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