How to Send Medical Insurance Refunds

Medical insurance companies have the right to request refunds when they pay in error. For example, if an insurance company processed payment for a member who had no coverage, it paid in error. If the insurance company paid for services that were not a part of the patient's benefit plan, it is entitled to request money back. Health plans may also recover money if they paid more than what was owed or if they determined another insurance is responsible for payment.

Instructions

• 1

  Call the insurance company.

• 2

  Identify yourself, the facility you represent and answer their initial questions. To be in compliance with the Health Insurance Portability and Accountability Act (HIPAA), they are required to ask patient specific information, such as the patient's name, date of birth, identification number, date of service and the amount billed. Also reference the claim number.

• 3

  Specify the reason for your call. Did you receive a refund request or do you think the insurance company overpaid?

• 4

  Ask questions. If you received a refund request, find out why. Was the patient eligible on that date of service? Did the claim process incorrectly? Is there another insurance responsible? Is this a duplicate payment?

• 5

  Identify the overpayment. Work with the insurance company to identify where the overpayment occurred and how much is to be refunded.

• 6

  Ask for an official refund request. This validates the overpayment and is documentation that should be kept on file, in case of an audit. If the overpayment is minimal and costs the company more to request back, the overpayment should be voluntarily refund to them.

• 7

  Document who you spoke with and ask for a reference number for the call. Be sure to confirm the correct mailing address for refunds.

• 8

  Refund the insurance company. Attach a check with a copy of the refund request. Identify the patient and why you are refunding the money. Include a copy of the Explanation of Payment (EOP) and claim number. Note that some health plans will not ask you to mail in a payment. Instead, they will withhold the overpayment on a future check.

• 9

  Follow up with the insurance within 2-3 weeks to verify the refund was received. If the health plan recouped payment on a later check, be sure you received a voucher indicating that.