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Phillips Esq.
Phillips Esq., Attorney-at-Law
Category: Employment Law
Satisfied Customers: 17504
Experience:  B.A.; M.B.A.; J.D.
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I am covered by multiple medical health insurances. Thus

Customer Question

I am covered by multiple medical health insurances. Thus there is a coordination of benefits. There has been mix up in medical reimbursements and my insurance that was paying as primary insurance now says that they should have been a secondary insurance and states that the other insurance should have been primary. Thus the used to be primary insurance is reversing charges to the doctors and the used to be secondary insurance is refusing to admit that they should have been primary, saying that I have not provided sufficient information at the time of service. Can doctor's offices now go after me for reimbursing them for the amount of reversal? What is the look back period? -- in other words can, for example, the used be primary insurance reverse the charges from two years ago?
Submitted: 11 days ago.
Category: Employment Law
Expert:  Phillips Esq. replied 11 days ago.

Hello: This isCustomer Welcome to JustAnswer! I am reviewing your post, and I will post my response very shortly. Thank you for your patience.

Expert:  Phillips Esq. replied 11 days ago.

I am sorry to read about your difficulties.

Your questions:

Can doctor's offices now go after me for reimbursing them for the amount of reversal?

Response 1: Unfortunately, yes. You are ultimately responsible for the bills.

What is the look back period? -- in other words can, for example, the used be primary insurance reverse the charges from two years ago?

Response 2: Yes. Regrettably, there is no specific look-back period for reversal of payments. Your insurance company can reverse a claim paid two years ago after the discovery of the error. However, if your primary insurance refuses to pay for the bills that it is now supposed to pay, you can file complaint against the insurance company with your State's Insurance Commissioner. Click here for more information.

Goodluck with your case,

Customer: replied 10 days ago.
after I have submitted the question I found this link http://www.amednews.com/article/20120726/business/307269997/8/and state by state
http://www.prorecovery.com/wp-content/uploads/2013/09/PRP-State-Insurance-Recoupment-Laws.pdfaccording to this there is a time limit for look back period which is 24 months in NY.Please provide a link which states that the patient is responsible if there is a screw up with coordination of benefits
Expert:  Phillips Esq. replied 10 days ago.

I respectfully ***** ***** the link that you have provided. However, I will opt out to give another Attorney the opportunity to comment on your case.

Best wishes,