How long does a insurance company have to ask for a refund?

Question

We are a medical office and have had some accounts be over paid. How many years later can they ask for a refund? After the time frame are we allowed to keep the money?

Answer 1

I'm guessing (key word) that if you know you've been overpaid for something that it would be your responsibility to repay it.  If a cashier gives you the wrong change do you correct them or do you just assume it yours?

If it's their mistake and you don't notice that's one thing, but that's not much different than picking up someone's wallet and deciding that you'll give it back only if they ask for it.

Just a thought and I'm sure you'll do what's right.

Answer 2

Our insurance company automatically recoupes the money after 45 days. Any future claims that come in for that provider (and ANY patient), then the funds are deducted from those claims.

oh nevermind..i misread your question..I have no idea HAHAH!

Answer 3

Well, it's going to vary state to state, but if it's the result of an audit, most companies have three full years AFTER the policy expires, to do the audit.  It could be longer, if you aren't cooperating.  

Bottom line - you need to check out the contract - it should be stated there.

Answer 4

You need to check your contracts with each insurance company.

There is no one specific answer that will apply in all cases.  When your office negotiated the contracts with each insurer, the refund rules/procedures would have been spelled out in the contract.

Additionally, if the person negotiating the contracts for your office was smart, they would have insisted on establishing the same time frame for your office to recoup any underpayments from the insurance company.

(You DO have someone auditing your insurance payments to make sure that you're getting paid according to contract, right?  If not, that's money right out the window...a person in that role more than pays for him/herself just by all the lost revenue they recover!)

Pull out your copies of the contracts with each insurer to find out.  Also, while you have the contracts out, it would be a good idea to create a spreadsheet or summary of some sort, so that you know the info for future reference.

The "standard" tends to be about 2 years, but again it all depends on what you agreed to when you signed the contract.  If you signed a contract allowing them 3 years to request refunds, then you have to uphold your end of the contract.