My question involves collection proceedings in the State of: North Carolina
Insurance is recouping payments made to my child's medical provider from 2004 - 2011. Is there a statute of limitations on their ability to sue me for these new "old" debts from say 2004-2008 given the 3-year statute of limitations that applies to most debts in this state.
Tricare, insurance for the military, has completed some type of internal audit and determined that my child was not eligible for benefits during a period of YEARS even though they gave authorizations, paid claims and continued to show him eligible for services on DEERS. This sudden revelation occurred for them in March 2011. They are reversing and recouping money from every providor my child has seen while under that insurance plan going all the way back to 2004.
The total monies they are recouping is around $50,000. I have gotten two calls from medical providers. One provider, a therapist office, is stating that Tricare is demanding a refund of $20,000.
Of interest, these providers have 30 days to reimburse the money to Tricare or Tricare will begin offsetting their claims. Meaning, if they have other clients with that same insurance, they will keep the money they would have otherwise paid for those patients and apply it to the debt they owe for my child's claims.
It's important to note that the insurance company has not contacted me about this at all. I had to contact them and ask them what was going on. They said I am not responsible for repaying the funds, the medical provider is. Yeah, but they must know that the medical provider is going to come after me for the payment. Tricare has compiled all of the claims they have decided to recoup on FINALLY sent me a list of all the providers they have contacted so I'm not completely caught off guard when the bills come. Already I have had two very unpleasant conversations with two different office managers. I feel like a sitting duck. Everytime my phone rings I cringe.
My child saw so many providers during this time period because that was the time period when he was being diagnosed with autism and was receiving all kinds of tests like sleep deprived EEG's. He saw psychologists, neurologists, speech therapists, occupational therapists, etc. etc. etc. and even had two surgeries on his back for a tumor he had developed. All these years later they want ALL of their money back from these procedures.
My question is, if a provider who was initially paid on time by the insurance company, has to reimburse my insurance company for services received from 2004-2008 etc. would their lawsuit likely be successful given the statute of limitations (I believe it is 3 years in this state for debts and unjust enrichment in NC).
This is a portion of Tricare's SOP handbook.
http://www.tricare.mil/to02/C11S3.PDF
Additionally, my insurance had a contract with Tricare so that the provider could not bill me anything above what Tricare paid. Now that Tricare is saying my child was not eligible, the medical provider is stating there was no contract and therefore I should have to pay a 100% of whatever they billed Tricare. So that if they billed 100.00 for one appointment and Tricare paid only 60.00...and then recouped 60.00...they would then send me a bill for 60.00 plus the 40.00 that was discounted pursuant to their contract with Tricare. Can they do that per the statute of limitations?
Thank you.
I guess I should have posted this under Debt Collections > Medical Debts (I just now saw that...sorry)

