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  1. #7
    Join Date
    Oct 2006
    Location
    supratentorial region
    Posts
    818

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

    It seems health care providers would point to agreements they have patients sign where anytime some disagreement between the insurer and provider arises, the patient is held holding the bag, and MADE TO PAY. In the ridiculous case you cited, the poor patient is then called on to make the payment. I find this even more ridiculous.
    I would assume most laypeople find the case I cited ridiculous. Over the years I've seen many changes and learned a lot of "ridiculous" things occur when dealing with insurance company decisions. Let me assure you it's true, and happens more often than you may think. IMHO, if the provider jumps though all the required hoops to obtain approval/authorization/payment for treatment, and in hindsight a year or two down the road the insurance company reverses it's decision, the insurance company should eat the cost...not the patient....not the provider.

    I myself was put in for collections by a hospital system after my insurer informed me and the state insurance department that the hospital bills were paid in full. The hospital claimed the bills were not paid in full and cited agreements I signed saying I pay what my insurer failed to pay. My insurer claims the payment were in line with an agreement they had with the hospital system.
    If the hospital/Physician/facility had a contract with your insurance company, they must accept the amount the insurance company pays...the "reasonable and customary" amount.... as payment in full. Any agreements are for the amounts an insurance company (even contracted) deems "not covered" by your policy, any co-payments, co-insurance and/or deductibles. If a procedure is not covered by your policy then the provider may collect the amount. One example I can think of off the top of my head would be an "administrative physical" (one for work, school, etc.) or lab work required for a non covered service, such as cosmetic surgery.

    Second, I pointed out that I marked "payment in full" on the check, and they accepted the check as payment in full.
    Writing "paid in full" on your check does not relieve you of your responsibility to pay. Accepting a check with that notation does not obligate me to forgive the remainder of your account balance.

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