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Insurance question

Posted: Wed Jun 29, 2011 10:35 pm
by CombatWombat
A few months ago I suffered a head laceration which required a trip to the hospital and the use of my insurance. A couple weeks later I got my bill (not cheap) and paid the full balance. Today I received a letter that politely told me the insurance company sometimes reviews claims for quality customer service at any given time afterwards. It went on to say that they paid too much of the deductible and now they want me to give them more money. I know it's not right and certainly no way to run a business! So how do they get away with it? I know I can't sell something, collect payment and then later on call the customer and tell them they owe me more money. How does this work, what should I do? Thanks to any insurance savvy folks out there.

Re: Insurance question

Posted: Wed Jun 29, 2011 11:19 pm
by BrianSW99
Have you checked the numbers and compared it to what your policy states? Did they actually make a mistake in how much they paid? If they really paid more than what is called for by the policy then I don't think you'll be able to get out of paying them back since the amount they're obligated to pay is set by the policy contract.

Re: Insurance question

Posted: Thu Jun 30, 2011 7:52 am
by AEA
How much more do they want?
If it's over 250.00 or so, spend that money on a Lawyer to review it for you and to write them a Certified/Registered letter informing them that there will be no further payments.

Re: Insurance question

Posted: Thu Jun 30, 2011 8:33 am
by Ed4032
Get your EOB and review it. It will tell the complete story of what happened and what you are responsible for.

Re: Insurance question

Posted: Thu Jun 30, 2011 9:31 am
by Ameer
Who says you owe money, the hospital or the insurance company? If it's the hospital, you probably signed something saying the payment at time of service is an estimate of what you owe, and you accept responsibility to pay anything insurance doesn't pay. The suggestion to read the Explanation of Benefits is a good one.