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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Overpayment
on a bill entitles you to a refund
April 2, 2004
Q:
My
husband saw his doctor for his ankle. We overpaid the
doctor's office before we realized that our primary
and secondary insurance companies were also paying for
the visit. I have called the doctor's office numerous
times with no results. Finally I sent them a registered
letter citing all of the payments made by us and our
insurance companies. It is simple math…we and our
insurance carriers paid them a total of $467.64. The
final amount owed to the doctor's office as shown on
our EOB is $252.99 which leaves a refund of $214.65
due to us. The office called me upon receipt of my letter
and told me that as soon as they received the payment
for my husband's last appointment they would refund
the amount due us. My insurance carrier informed me
that the doctor's office cashed that payment last week.
I still have not heard anything from that office regarding
a refund. I don't even know if their figures agree with
mine. I can not get an intelligent response from them.
We paid their bill in good faith within a week of receipt
because I mistakenly thought that is what I owed. I
thought getting a refund would take just a week also.
Can you assist us?
A:
I
suspect your primary insurance paid their portion of
the bill. You received an EOB, explanation of benefits,
from them indicating the balance. You may have also
received a bill from the doctor's office before they
received payment from your secondary insurance company.
You paid that balance and so did your secondary insurance
company. You are entitled to a refund immediately. Your
refund should not be tied into any other bills from
other appointments. It is just a cleaner, simpler and
a less complicated way of bookkeeping. Then if there
is any problem with future claims, they can be dealt
with separately. One problem won't depend on the other.
Keeping the billing issues separate from each other
will make deciphering multiple problems easier with
future bills. Of course, if you agree to keep the overpayment
in your account until the next bill is paid, make sure
that that bill was processed and paid correctly.
You
need to call the head of billing again. Tell her that
you want to go over your billing immediately and you
expect a refund within a week. If she can not resolve
this for you, speak to the office manager. If there
is still a problem, speak to the doctor. He may have
no idea that there is a billing problem unless you inform
him. You can also call your insurance company and if
the doctor is in-network, they may be able to provide
some recourse for you. A doctor's office may not keep
your overpayment. If there is still a problem getting
a refund, you can call your local state medical board
and also your state health insurance board.
If
the overpayment to the doctor's office is the result
of overpayments by both you and the insurance companies,
you are only entitled to a refund of the portion of
the overpayment you made. The insurance company is entitled
to their share of the overpayment. If and how they collect
that refund is between your doctor's office and the
insurance companies themselves. But you should not receive
the insurance companies' overpayment. Going to the doctor
should not be monetarily profitable for the patient.
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