Can You Appeal an Insurance Company’s Refund Request?

Lately, we have been seeing a number of recoupment requests for dates of service and payments that occurred nine, twelve, or even 18 months ago. The reasons vary, but typically the insurance company says they overpaid for some of the CPT codes or that the patient didn’t have coverage at the time of service.

What should you do in this situation? Check to see if you can APPEAL!

There are limits on how much time the insurance company can ask for the money back. Be sure to check contractual and state deadlines and file the required paperwork so that you still get paid for the visit.

If you have a billing company, they should take care of this for you. If you do it internally, it’s a pretty easy process.*

Steps to Appeal:

  1. Check to see how much time they have to recoup. 
  2. Appeal, following the instructions provided either on the refund request letter or on the insurance company’s website.
  3. Escalate to the state, if necessary.

It’s pretty easy and could save your practice several thousand dollars each year.

*At Altus Pediatric Billing, we file appeals for all of our clients for refund requests as well as other issues we come across. When appeals get denied we continue to appeal until it is resolved.