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Can you tell me how an insurance company would typically…

Hi can you tell...

Hi can you tell me how an insurance company would typically resolve insurance health claims that have been submitted in error?

Lawyer's Assistant: What state are you in? It matters because laws vary by location.

Ontario

Lawyer's Assistant: Has anything been filed or reported?

Filed how? I went to my insurance company when I noticed discrepancies in my claims

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Answered in 3 minutes by:
3/11/2018
Debra
Debra, Lawyer
Category: Canada Law
Satisfied Customers: 105,605
Experience: Lawyer
Verified

Hello! My name is Debra (formerly known as Legal Ease). Thank you for your question. I'm reviewing it now, and will post back again shortly.

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I am sorry to hear that you sound like you may be in a bit of a difficult situation.

Are you saying you made claims online but now have realized that you erred?

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Customer reply replied 4 months ago
correct.

Did you make claims that you do not have receipts for

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Customer reply replied 4 months ago
although there are a couple that my naturopath thinks she has some for. i've asked her to look into it for me too.
Customer reply replied 4 months ago
If I am ready and willing to work with the insurance company on this (I called them first) and prepared to pay any money owing would that normally be satisfactory?
Customer reply replied 4 months ago
hello?
Customer reply replied 4 months ago
is someone still there?
Customer reply replied 4 months ago
i never heard back from anyone.

You never heard back because you opted me out. I was in the middle of helping you and you got impatient I suppose. This is not an instant chat and I was helping other customers. When you opted me out you locked me out. Clearly no other expert wanted to step in. They would not when you did this for lack of patience I assume.

I am certainly willing to continue with you if you like but first let me know that you do wish to confirm.

Thanks

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Customer reply replied 4 months ago
Hi Debra
I did not know this was the format. Please understand that while you view me as impatient it is just someone on the other end who is worried about her situation and has never used this service before - hence why I was sending messages asking for clarification. When I did not receive any clarifying messages back, I thought we were disconnected.

That is fine. I do understand which is why I am happy to continue.

Is the bot***** *****ne that you put in more claims than you can provide receipts for and then got worried so reported this to the insurance company? If so what exactly did you tell them?

Did you pay them back for the overpayment they made to you?

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Customer reply replied 4 months ago
I told them that I wasn’t sure what happened but it appears to be inconsistent. I have offered to pay any overpayment I owe.

What did they say?

How much is the overpayment?

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Customer reply replied 4 months ago
They told me they understand some errors can occur. They asked me to send in the dates I am unsure about. I talked to my naturopath and she is looking at her booking history as well. I am not sure how much , a few hundred likely.

I get this question a lot and generally the amount at stake is much more and there are not receipts. It has all been fabricated. And in all cases they get caught and didn't make a report first.

So I honestly don't think you have any concerns. First, you do have a lot of receipt and it looks like you may even get more. As well you came forward on your own and the amount is quite small.

So what I suggest is you simply gather every receipt possible and then figure out the overpayment. Then contact them and say you want them to confirm that your calculation is correct so you can pay them back. When they do confirm the amount pay them the amount immediately. I do think that will be the end.

Please feel free to post back with any follow-up questions you may have. If you don't have any then I hope I have earned a 5 star rating but if you don't feel that I have please don't hesitate to reply back and let me know what more I can do to assist you. Finally, please know that even after you rate me I will be here for you and you can ask follow-up questions if you think of them later on at no further charge of course.

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Customer reply replied 4 months ago
Thank you. May I ask you to clarify your first paragraph? It doesn’t make sense to me.
Customer reply replied 4 months ago
I will rate you favourably :)
Customer reply replied 4 months ago
The amount is likely within 700-800 I am thinking. Depends what my naturopath finds because she thinks there are a couple wrong dates. I have either lost /don’t have the receipts or I’ve carelessly submitted incorrectly or too much. Hence why I’m worried.

What I was saying is that this type of question is posted on this site all the time.

But your case is much better than the others I have seen.

In all the other cases there is essentially fraud. Someone makes multiple claims and there are no receipts. And then they get caught. Then they come to the site in a panic. They end up getting charged and losing their job.

But in your case you were just not careful. You didn't submit multiple claims and you are hoping to be able to gather some more receipts. And you reported this to your insurers.

So for these reasons I believe they will believe you and let this go.

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Customer reply replied 4 months ago
What if there are multiple ones though? What is the typical amount that they go to lay a criminal charge?

There is no typical amount but as you came forward, do have some receipts and are paying them back the hope is they will let this go.

It if becomes clear there was an attempt at fraud they won't though.

Debra
Debra, Lawyer
Category: Canada Law
Satisfied Customers: 105,605
Experience: Lawyer
Verified
Debra and 87 other Canada Law Specialists are ready to help you
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Customer reply replied 4 months ago
Ok thank you
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