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Is there a statute of limitations for a Health Insurance Company, to request a refund on a payment they made in error?
Anonymous1 views2 answers
One year and three months ago, I received
an MRI, and my Health Insurance Company paid the Medical Group for their services. Now, after all this time, my Insurance Co. said the treatment was not an approved procedure.
They are requesting that I refund the payment they made to the Medical Group for the MRI.
After all this time (1 year and 3 months) is the Health Insurance Company still legally within the time frame for requesting a refund for a payment they made in error?
If still bound by law, to refund the payment to the Health Insurance Company, shouldn't the Insurance Company demand the refund from the Medical Group and in turn, I would be responsible for reimbursing the Medical Group?
Thank you
In CA, the statute of limitations for written contracts is 4 years, but your health plan policy may proscribe shorter time frames for payments and reimbursements.
Review your health plan documents. There's probably an appeal and grievance procedure you can use, or you can contact our employer's benefits representative to inquire, or hire a lawyer for help.
Disclaimer: Please note that this answer does not constitute legal advice, and should not be relied on, since each state has different laws, each situation is fact specific, and it is impossible to evaluate a legal problem without a comprehensive consultation and review of all the facts and documents at issue. This answer does not create an attorney-client relationship.
The answer to your question will be set forth in your insurance policy. The insurance policy is a contract that sets out the rights of an insured AND the insurance company.
Since the insurance companies write the language in the policies, you can be sure that they protect themselves. Insurance companies would have addressed this issue in your policy.
Typically, most states have a four year statute of limitations on contract related issues. This may differ from state to state. Check with a local attorney of your choice.
