Can my health insurance company bill me for claims they already paid?
My insurance company is telling me they may be terminating my coverage retroactively past 12/31/09. I’ve had claims from months ago that the system says they already processed and paid by my insurance company. Does this mean the insurance company will come after me for that money or would they only try to get me to pay for unpaid claims?
Tags: already, Bill, claims, Company, Health, Health Insurance, health insurance company, Insurance, Insurance Company, Paid, They
They will pay claims occurred up to the date of the termination. They will require that the providers refund any payments made for claims after that date. The providers will then bill you, not the insurance company.
The insurer does not bill you. Any bills (for services not covered by the insurance) come from the providers themselves. If the insurer paid claims that are subsequently determined to be not covered, those payments are reversed.
As to the insurer terminating your coverage, that is a separate issue that you do not fully explain. WHY is the coverage being terminated?
Yes, the insurance company will be coming after the money paid on claims after 12/31/09. This situation is called an overpayment. I can see this happening one of two ways:
1) Your insurance company will take the money back from the provider. Either, the insurance company will request that the provider write a check or the insurance company will withhold the money from future payments. This will cause the provider to contact you and make you pay.
2) Your insurance company will take money back from you. Either, the insurance company will withhold the amount from any premiums you paid for 2010 (and would be due back) or request payment.
If the checks were issued to the provider, I would assume that the insurance company would go with Scenario 1. If the checks were issued to you, they may go with Scenario 2. In either case, you are going to want to get in contact with your providers to work out a cash price for your visits and avoid getting your account sent to collections.