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  1. #5
    Join Date
    Oct 2006
    Location
    supratentorial region
    Posts
    818

    Default Re: Preapproved, Paid, Now Insurance Wants Money Back

    .... if I was your patient, not only would I not pay, but I would most likely sue if I was asked to pay bills for treatments found "medically unnecessary".
    Wouldn't that depend upon what the insurance company's definition of "medically unnecessary", and why it took two years for them to come to that conclusion?

    Example: Patient presents with a history of GI bleed, is complaining of burning/stomach pain after eating, and a positive at home test for blood in the stool. Doctor orders a very basic blood count (CBC) ....totally logical, right? Insurance company comes back a year later (after paying the claim), stating the CBC was "medically unnecessary". Why?...because the CBC results came back within normal limits. Isn't hindsight wonderful? Ridiculous.

    Obviously, OP did his/her homework by submitting treatment plans which supported the initial decision by UHC to authorize treatments. They then continued to pay for 22 visits. Now, 2 year down the road, they change their minds and demand their payment back? IMHO, it's disgusting.

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