11/28/2022
Time frame for Recoupment-Notice from Excellus BCBS Regarding Overpayments
I am a life member and have been retired for 5 years. I received a notice from Excellus BC/BS of a 3 claim overpayments totaling $455 from June of 2017. Does the insurance company have the right to go back that far for a refund? I can obtain the medical records from the DOS. Can I appeal. The insurance company did not provide me with a reason for the overpayment adjustment.
If a provider is retired, they have no way to recoup the payment and will ask you to submit the refund check. Depending on your contract at the time and what it states you would need to follow those guidelines and to see if they are still in effect after retirement. I would however defer to legal for that advice.
Depending on the time limit and statute of limitations which seems to be 2 years from payment date, there are 3 exceptions to how far back they can go…
- Fraud or abuse
- Self-insured plan
- If this is a state or federal Medicare or Medicaid Government program
If the insurance in question has a specific period in their contract, then that prevails over this law however again I defer to legal.