Can an insurance company recoup money from a client after already paying a claim?

Question

I have been paying on a hospital bill that my wife incurred about a year ago. On last months bill there was an additional 1300 dollars added to the bill. I called the hospital and they told me that my health insurance co. recouped the money and now it is on my bill. I asked the hospital to send me some kind of proof that this is what really happened, but they said they could'nt. Is this legal and how do I know someone is not just pocketing the 1300 dollars. I don't want to contact the insurance co. because if it is a scam I don't want them to get wise to my inquries. Is this legal and what should i do? ty

Answer 1

Go a head and contact the Insurance company. This sounds fishy. Why would the hospital give your insurance the money back. The insurance company would come after you if they made a mistake. The hospital should also show you proof.

Answer 2

Some states have laws regulating how and when an insurer can recoup money that was already paid due to a claim.  Contact your state's insurance commissioner's office and ask about this.

Also, you should contact your insurer immediately.  It's been my experience that some incompetent hospital billers *assume* that when an insurer recoups money that the patient can be billed.  This isn't always the case.  So call your insurer and ask 1) why the money was taken back; and 2) whether you're responsible for paying this amount to the Hospital.  If you're not liable, ask your insurer for assistance (you may have to put your request into writing).

Answer 3

I'm not surprised, Republicans hard at work manipulating the laws in there favor.

Answer 4

Contact the insurance carrier. If they had paid some portion of the bill and later determined that they should not have paid it, they would have contacted you directly, not through the hospital or by getting money back from the hospital. If they did indeed for some reason rescind a previous payment, they owe you a letter validating this denial of the claim amount and allowing you the opportunity to appeal this decision. The hospital should also be able to provide you with a detailed account statement showing all charges, payments and other activity on your account. By saying they "can't do this", they are in effect violating fair debt collection laws. Contact both places and request written statements of your account activities. If need be, do this in writing and mail the letters with delivery confirmation so you have proof of service. Keep hounding until you get answers- health care and insurance costs are high enough in this country without hospitals and health insurance companies doing things like this. Unfortunately, this isn't uncommon.

Answer 5

Why wouldn't you want to contact your insurance company if you are getting scammed?  That sounds strange.

Why do you care if "they get wise to your inquiries"?

Insurance scams drive up premiums for everyone - including you!  And people wonder why it is so $$$$

if your hospital is a "Preferred Provider" of your HMO (assuming thats what you have), then the insurance company and hospital have an agreed upon amount for each procedure, etc.

The hospital should be able to provide you with a bill that you can fax to your insurance company to iron out - otherwise, do not pay a thing and contact an administrator at the hospital for answers.  If they are scamming you, insurance companies will pull out of that hospital!