retract a payment?

Question

what does it mean for an insurance company to retract a payment? does it mean that they take the money back from the dr and bill you? if the insurance company pays a dr bill, how can they then take the money back?

Answer 1

Yes - when a payment is "retracted" from a doctor, the insurance company takes the money back from them. And the doctor's office can bill you for the amount, if its something that you're liable for. (Say if your policy was canceled or if the service shouldn't have been covered, etc.)

Insurance companies generally send large bulk payments to medical providers for multiple patients all at once. If the insurance company makes a payment for you that shouldn't have been made, they can either request a refund from the doctor *or* withhold payment from the doctor's next check.

So, if the doctor regularly treats patients from your insurance company, they'll get a short check the next month if one of your services is reversed. (Say the insurer owes the doctor's office $10,000 for July, but they retracted a payment for $1,000 services for you. The insurer will just send a check to the doctor's office for $9,000, and the doctor will come after you for the difference.)

Answer 2

It depends on why the payment was retracted. The insurance company may have made the payment in error (wrong provider, too much money, etc). Or, the provider's office may have failed to provide documentation after an audit request. If the latter is the case, the doctor's office can't get the money back from you. The doctor's office can collect from you if the reason for the retraction is due to your eligibility of policy. The EOB you receive from the ins. company will let you know if you are responsible for the balance. Any questions, call them directly. The doctor's office might be able to answer the question for you but likely have just as much information as you.

Answer 3

Insurance companies often conduct internal audits, and do find payment errors. Sometimes they pay some things they should not have - for example, if someone's coverage lapsed, but the claim got paid anyway, or the insurance paid for something that's not covered on that specific plan, or they just didn't take out the provider's discount. In which case, they send the doctor a letter asking for the payment back. In the case of lapsed coverage or paying something that generally isn't covered, you'd better believe you're going to get a bill! (Which you should be expecting anyway, since you knew you went to the doctor with no health insurance or that they did something that your plan doesn't allow.) In which case, you can ask for a discount and payment plan. If it's a case where the insurance forgot to take out the discount, no body owes anyone anything.

Answer 4

Insurance companies pay lots of claims to doctors electronically to their bank accounts, so they can sometimes draft the money back out the doctors bank accounts (depending on their contract with the doctor). At that point, the doctors office will come after you for the money that the insurance company took back. And because they probably gave you a discount for using an insurance company they contract with, the doctors office may come back and ask for your even more money since you may not qualify for the discount if the insurance companies refused to cover the services.

Had you received an explanation of benefits showing what was paid and any adjustments? Did anyone notify you before you went to the doctor that the services would not be covered? If not, you can fight it. You can appeal the decision or contact your state department of insurance.

Answer 5

oh sounds like you're in the same unfortunate situation as me: my premium was reversed by my credit card company and i just found out that the insurance company will retract (take back) the payment of claims to the dr.'s office and the dr's office will now come after me. i am setting up a payment plan with them