What are my rights/responsibilities regarding an insurance overpayment?

UPDATED: Jan 3, 2015

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What are my rights/responsibilities regarding an insurance overpayment?

Several months ago my child was seen in an emergency room. The insurance company sent me the check for the doctor’s fee and I co-signed it directly to the doctor for payment. Now, 5 months later, the insurer sent a statement telling me that they overpaid and I was to reimburse them. How is that correct?The same company authorized a test, gave me an authorization number but when I had the test it sent me a statement that they would not cover it. How is this legal or fair? Do I have to pay back the insurance company for what the doctor received and for the test my doctor ordered and was authorized?

Asked on January 3, 2015 under Insurance Law, New York


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 8 years ago | Contributor

Yes, if you were paid more than your insurer should have paid, then they can seek reimbursement from you. Had the check gone directly to the doctgor/hospital, then they would be responsible for the overpayment; however, because it went to and was written to you, you are responsible for the overpayment--if it was an overpayment.

You can try to challenge the claim that there was an overpayment on the grounds that they had authorized the test and thus should cover it, but if the amount of money is not large, it may be best to simply repay them--contesting issues can be very difficult and time consumming.

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