Guest guest Posted June 2, 2011 Report Share Posted June 2, 2011 Group. We are an out of network provider for United Health Care. Patients were seen over 12 months ago. UHC is now requesting partial reimbursement for services rendered and paid for at this clinic. Hard to believe, reason stated, they overpaid for services. Have any of you had similar requests? Did you respond? Is there a statute of limitations on such requests? Roll PT Center of Ocean Springs Ocean Springs, MS www.ptcos.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 3, 2011 Report Share Posted June 3, 2011 Personally I would have a difficult time trying to respond to this letter with any words that are larger than four letters. Of course sometimes when I am in a better mood, my thought process is on the high road and I write a response along the lines of: " we have a company policy that states all overpayment requests must be made by certified mail, written in swahili and must be received within 90 days of your original payment. " Unfortunately, your request exceeded our policy and therefore, you have exceeded the statute of limitations for requesting a refund. If you believe our policy is unfair, you can make an appeal to the Reimbursement Chair of the Clinic, and they will review your request within 180 days and get back to you. Should you decide that you want to explore this avenue, you will need to submit a page for each CPT code that you feel you paid inappropriately, clearly indicating the patient's name, our account number, the amount we charged, what you actually paid us and how much you feel you overpaid along with a written description from your Medical Director on the validity of the medical necessity of the overpayment refund request. Blah, blah, blah and so forth. Also, make sure your envelope is hermetically sealed..., as failure to do so could make you forfeit your right to this refund. Oh..., and good luck, we will be in touch. Sorry, sometimes I just write these things for my own amusement, but I hope you find a policy worth implementing somewhere in this email! Jim <///>< UHC overpayment Group. We are an out of network provider for United Health Care. Patients were seen over 12 months ago. UHC is now requesting partial reimbursement for services rendered and paid for at this clinic. Hard to believe, reason stated, they overpaid for services. Have any of you had similar requests? Did you respond? Is there a statute of limitations on such requests? Roll PT Center of Ocean Springs Ocean Springs, MS www.ptcos.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2011 Report Share Posted June 7, 2011 Hi, On yesterday's RACMonitor Monday conference call, from the Patriot Group in Boston was a guest expert speaker. He gave very detailed instructions on how his company (they do this for a living) handles claims from out of network providers (they appeal every one when they get an EOB) and his suggestions for dealing with these ins cos. that keep squeezing us. You can hear a rebroadcast of this by going to www. RACMonitor.com and selecting the archived one from June 6th. It may not be up yet . If you would like to contact him in Boston, give Colleen Raab a call at 866 - 829-6612 x 705. He gave very explicit things to do and examples of what to say to the insurance cos. when you communicate with them. He is getting excellent results obtaining more reimbursement than the low figures many on the call are getting. Sally -McNamara, MCS, CCC-SLP, CCP, CCE Certified Healthcare Compliance Executive Consultant UHC overpayment > > Group. > > We are an out of network provider for United Health Care. > > Patients were seen over 12 months ago. UHC is now requesting partial reimbursement for services rendered and paid for at this clinic. Hard to believe, reason stated, they overpaid for services. > > Have any of you had similar requests? > > Did you respond? > > Is there a statute of limitations on such requests? > > Roll > PT Center of Ocean Springs > Ocean Springs, MS > www.ptcos.com > > Quote Link to comment Share on other sites More sharing options...
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