What would you like to do?
Can an insurance company request an overpayment refund at any time Is there a time limit?
Texas Prompt Pay Law - Time Limitation (TAC 21.2818)
- 180 Day Limit: This applies only to claims subject to the Texas prompt pay law (enacted under Senate Bill 418) and were originally paid under SB 418 provisions. If 180 days have lapsed from the date payment was received, no refund is due
- Application: In general, the Texas prompt pay law applies to fully insured HMO and preferred provider organization products licensed and sold in Texas. It does not apply to other plans, i.e., Medicare, Medicaid, workers' compensation, TriCare, self-funded employer ERISA plans, state and federal employee plans, indemnity policies, and out-of-state Blue Cross plans (BlueCard) filed to Blue Cross and Blue Shield of Texas.
- Effective Date: The Texas prompt pay law applies to any contracts that were new or renewed on or after Aug.16, 2003. To determine if SB 418 applied when the original claim was paid, check the date or renewal date of the contract with that particular carrier; the effective date of the Texas prompt pay law will vary by payer.
- Prior Claims: For claims paid before enactment of SB 418, the time limit for refunds is based on individual contractual agreements. (Read your contract language and/or other carrier publications.)
- Automatic Recoupments: Carriers must first send a written refund request before automatically recouping money from current payments. After 45 days, if the carrier does not receive the refund or a written appeal, it can recoup the refund from any current payment.
- Noncontracted Physicians: The 180-day limit applies to claims paid on or after Aug. 16, 2003, and are subject to SB 418 provisions).
- Verification: Verification, as defined in the Texas prompt pay law, is the ONLY guarantee of payment that a payer cannot recoup later. "Preauthorization" or simply "obtaining/verifying benefits" is not a guarantee.
- Self-Funded Employer ERISA Plans - Time limits are based on individual contractual agreements. Nothing prevents carriers from automatically recouping refunds from current or future payments, regardless if the physician is contracted or noncontracted.
- Medicare Overpayments - In general, there is no practical time limit after which Medicare cannot ask for money back. TrailBlazer Health Enterprises, the Medicare carrier for Texas, is required by contract to pursue refunds on overpayments. Automatic recoupments from current and/or future payments are permitted.
- Medicaid Overpayments - In general, Medicaid may request refunds for up to five years. Depending on the circumstances, this time frame can be exceeded.
- Civil Practice and Remedies Code §16.004 - In rare situations where no contract language governs refunds and SB 418 does not apply, the statute of limitations is four years (excluding government programs).
- Preauthorization - For all payer types, preauthorization pertains only to medical necessity and is never a guarantee of payment.
- Wrongful Retention - A physician should never retain any amount truly not owed to the practice. Wrongful retention of an overpayment is called "conversion" and is illegal. If the practice did not perform the service(s), or if the reimbursement is clearly more than the plan owes, the practice should return the overpayment.
2 people found this useful
Was this answer useful?
Thanks for the feedback!
Yes, you can buy as many insurance policies as you like. But you can not make the same claim with multiple companies for the same loss or that could potentially constitute… a fraud. Your main Insurance policy ( typically that with the broadest coverage would be considered your primary coverage. Other policies (Trailing Coverage) can invoke if the loss you suffer exceeds the limits of the Primary Policy.
The coach can can call a timeout anytime when the ball is not in play. He/She only has two timeouts per game, though.
No. Pursuant to recent federal law, a plan can only go back five years from the payment date to request a refund.
%DETAILS% Answer No. In fact, the benefit will usually grow at interest until the insurance company can locate a beneficiary. One thing that some people don't… consider is the fact that often an insured dies and no one knows he had insurance. Since no claim is made, the insurance either assumes he is still alive (in the case if a paid-up policy) or any unpaid premium notices will alert the executor that there is a policy in force. If the policy had been paid up and no one makes a claim, the insurance company will start looking for a beneficiary at the time when the policy was to mature. (Usually at the time when the insured would have been 95-100 years of age) Answer My company used to sell insurance all over the world, including in Russia before the 1917 revolution. We left there shortly after World War I when the ruble was made non-convertible and we couldn't continue to operate. Back in the late 1980's, someone brought me a copy of a policy on a relative who had died in the '50's. The policy had been "paid-up", meaning no more premiums were due. My company had been holding the money waiting for someone to file a claim. After providing evidence of death and convincing us that they were direct descendents of the insured, we paid them the original face amount (not a huge sum) plus interest on that amount calculated from the date of death (which was a pretty large sum). So there's no time limit. It might get harder and harder to prove you're the right person to receive the proceeds, however.
There is no time limit
Sure, I am an insurance broker, appointed by multiple companies. If I were exclusive like a state farm agent, that's all I could sell is state farm.
What is the time limit if any for reporting vehicle damage from an accident to the insurance agency?
Answer I don't believe that there is a specified time limit in most cases, however the longer you wait the more problems you are likely to encounter. One p…roblem might be the existence of additional damage caused by a delay in getting the damage repaired in a timely manner.
Yes, you can cancel any policy at any time, and expect a refund for the used portion of premium paid.
Individual plans can be purchased anytime. Most group plans have open enrollment periods, or are available for enrollment after your probationary period (90 days). … Medicare has specific enrollement periods each year.
Sure. If for some reason you were overpaid for a claim the company can expect you to return the overpayment. I really don't see how this could have occurred unless you int…entionally did something to cause it to be done.
90 days from the date of service
Claims process No, you may file a claim at any time after the death of the insured. The claim should be paid plus interest minus any charges, loans or prem…iums owed to the company. This assumes the policy was active at the time of death. The agent or your agent can help you file the claim. 4lifeguild
To know if there are vacancies within the company someone will need to know what company is being referred to. Since the company name is not given there really is not a wa…y to know if there is a vacancy.
The statute of limitations regarding insurance refunds in Florida is 20 months. Cases that are found fraudulent are exempted from retroactive claims.
Generally the best thing to do is to secure the new insurance, and then present the documentation of the new insurance to the old insurer so that they can cancel that policy a…s of the effective date of the new insurance. Your new insurance company may take care of this notification for you. This sequence will avoid any gaps in your coverage.
Yes. Unreturned unemployment benefits overpayments may be deducted from your federal income tax refund.