Can my medical insurance take their money back after paying?

Question

i had a car wreck in october of last year. i went to the emergency room that night and gave them my medical insurance information. i went back the next day because i passed out. i used the same insurance information. well i also have med. pay on my car insurance. after my medical insurance paid their portion i gave my car insurance company the remainder of the bills and they paid the rest. they actually over paid the hospital. my medical insurance company found out that i had med. pay and decided since it was "injuries sustained from an automible accident" they wernt going to pay and have requested their money back from the hospital, which they did. i continue to get the bills from the hospital because the insurance company took the money back. the hospital sent me the overpaid portion of the bill and now my medical insurance has sent the hospital another letter requesting more money back because they were "overpaid". can that medical insurance company do that? if their not going to pay because of the type of injury..then why do i pay insurance every two weeks? its pointless because all the money is coming out of my pocket. im at my wits end on this. i cant get any kind of answer from anybody. somebody please please please help!!!

Answer 1

Here's the deal (and sorry if someone already said this but I didn't read through all the answers)...when there's a car accident and the medical insurance pays w/o knowing you went through a car insurance, they can definitely take back the money once they figure it out as they really weren't supposed to pay in the first place....

When you have more than 1 insurance company paying a bill, the one that pays first (in this case, the motor vehicle insurance) will do what they need to do with the bill----pay whatever portion they pay. Then you (or your doctor, or hospital, or wherever the service happened) will submit the additional bill (if there was any money left over after the car insurance paid) to your health insurance. Your health insurance will look at what was already paid by the motor vehicle insurance and figure out what they will pay additionally. The reason they asked for their money back is because they need a statement (usually called and EOB or explanation of benefits) from the auto insurance to show what has already been paid on that bill. If they don't have that, they have no way of knowing what they are supposed to pay.

For example, if your ER visit was $1,000 dollars, and your auto insurance pays $600, but they sent the bill to the health insurance w/o telling them you had auto insurance (so your health insurance has no idea you filed a claim with the auto insurance and they think they're the only ones paying the claim) they'll pay their full amt, which may be like $900 for instance....the hospital is now getting way more than they should be since 2 insurance companies are paying it w/ no idea the hospital is getting paid twice.

If the health insurance knew, they'd only be reimbursing based on the balance of $400, not the full amt. Soooo the health insurance will still pay your bills--they just need statements from the auto insurance to say how much has already been paid. Even if the auto insurance denied a bill, they just need a statement to say they denied it.

If that doesn't make sense, feel free to e-mail [e-mail]

Answer 2

Yes, a health insurance company can absolutely take back money after paying a claim, if its determined that they weren't the ones responsible for the payment.

If your auto's med pay was determined to be primary for the accident, then your health insurer would request a refund for the payment they made as primary.

If your health insurer should be liable for any amounts after the auto carrier's med pay exhausted, then the hospital would need to send them an itemized statement of exactly what was paid by your auto carrier.  That way, the health insurer can coordinate the benefits and make sure that the same services aren't being paid twice.

Answer 3

Yep. It's allowed. What happened was your medical insurance didn't check for coordination of benefits - some injuries automatically flag claims for that - basically, it's an insurance company's way of trying to "weasel" out of paying a claim. Why should they pay if someone else is responsible.

Your car insurance should have been the primary insurance in this case. You need to contact them ASAP and let them know what's going on, so they can pay what's left of the bills so you don't get sent to collection and your credit ends up in the toilet.  

Answer 4

Indeed they can.

Your medical and car insurance aren't supposed to put you in a better position than you were before the accident, so if they overpaid they sure should get that money back.  When you got the money from the hospital the best thing to have done would have been to call your medical insurer right then and return the money.

Also, your medical insurer isn't asking for the money back because of the type of injury, they're asking for it back in part because the injuries were the result of a car accident.  State laws are clear in that your car insurer should have paid first with your regular medical coverage paying what your car insurer does not.  Medical payments coverage, a terrific add-on to your auto insurance, should be used for medical bills before anything else (medical payments can also pay lost wages, but medical bills should be paid before lost wages), so your medical insurer should not have had to pay those monies either.

Check with your auto insurer to see if you've exhausted all of your coverage from this accident.  They may be willing to pay a part of it if you still have some medical payments coverage left.

From what you describe, though, it seems like you do owe your medical provider for what they paid that they should not have.  The money wasn't supposed to go in your pocket to begin with, so you're just paying back what you should never have received in the first place.  Ask them if they'll take payments.  They probably will.

Sorry!  I know you wanted a different answer, but this is the ugly truth.

Answer 5

yes this is perfectly legal.  Car insurance should always pay the bills incurred due to an auto accident.  

Answer 6

Yes they can. In fact... this is the way it works.

Auto pays for injuries sustained in the accident.

Typically, Health Insurance pays your medical claims first. If there's a settlement, the auto pays for the injuries. Then, your health insurance is refunded.

If you received a settlement, you are obligated to pay the hospital. If there was no settlement, your auto should be paying the hospital. If your auto is exhausted, then send the proof the auto insurance is exhausted to the medical insurance; & typically, they will pay more.