August 10th, 2015
Refund demands from payers are not all alike; some could be justified. Recently a payer asked for a refund request from a ChiroCode subscriber. She said: "We sent the No Refund letter from ChiroCode. However, they ignored it and they still want a refund. What do I do next?"
Demands for a refund from a payer can be various. It is similar to patients being different. Our No Refund letter is focused upon the “good faith” principles by both parties (provider and payer).
Our research on this case revealed that the original billing was for $152. The payer initially paid most of it. Their demand letter stated that only $25 should have been paid.
Significantly, there was a contract between the doctor and payer that specified that only $25 per treatment would be paid. Thus, the $25 amount was agreed upon in advance by both parties. According to the terms of the contract, both parties (doctor and payer), knew or should have known that only $25 was to be paid. Also, the patient probably had a copy of the policy or a summary plan description which outlined the benefits.
Our recommendation to this office: Refund the money immediately. It seems to be an appropriate expression of “good faith.” Realistically, the office should have known months ago when it was overpaid, that an error was made.
We are not attorneys nor do we give legal advice. However, why even bother an attorney when this matter seems so simple and ethically correct?