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The 411 on Refunds to Patients

Updated: Jul 25, 2023

By Martine G. Brousse

"The Medical Bill Whisperer... and insurance stuff too"

Patient Advocate, Certified Mediator


June 6,2023

Do you know the status of every account you hold with every medical provider? Are you sure they can be trusted to refund you what you overpaid? As a previous billing manager, I can attest to an ugly but all too common practice: credits owed to patients are too often not sent back. After all, it improves their accounting and provides additional income.

But is time to come clean with patients who are, after all, customers. Does the clerk at the supermarket, or at any other business, demand your formal request to hand over your change? Doesn't your credit card company statement show a credit balance?

1. Why is it happening?

Insurance reimbursements take a couple of weeks at best, months at worst. Charges may be denied, appealed, or payments recouped down the line.

Few providers can afford such delays before they are paid properly. Patients are billed soon if not immediately, even if their final liability has not been confirmed.

The other major side to this sad story is "office policy". Don't ask? Don't get!

2. Common reasons for credit balances:

· Hasty Payment: your claim had not been processed before you pay the first bill

· Pre-Payments: the office demands payment up front, to cover a deductible for example, before the insurance has established your final liability

· Double coverage: you have two policies, and both payments exceed the amount owed to the provider

3. What can you do?

a. Due Diligence

· Keeping track of your bills, insurance explanations of benefits ("EOB") and payments is crucial. Any statement not matching an EOB should be questioned.

· Request a copy of your ledger, or itemized bill, at the end of each year, or after a visit to a medical facility. Useful for tax purposes, it will allow you to scan for errors and confirm balances.

· Get receipts for any payments, especially if paying cash. Indicate whether this is an advance on a future (accepted) liability, a monthly payment or payment in full.

· Avoid paying in advance, except for co-pays as per your insurance policy. Anything else should wait for confirmation on an insurance Explanation Of Benefit (“EOB”)

b. Consult legal mandates

CA’s refund law forces medical providers to refund overpayments within 30 days of a legitimate request or of finding out there is a credit on an account. Does your State? Google, your State’s Attorney General’s office or your State’s Legislature website will know.

c. Ask ASAP

· At any suspicion or proof of overpayment, contact the billing office for a refund in writing.

· If your request is denied because of “office policy” and there is no State law on your side, ask for a copy of that policy. The rationale behind holding overpaid funds is usually fear of a future recoupment by the insurance. This delay should only last as long as your policy’s or State’s stated time limit for a recoupment. (365 days in CA for example)

d. Contact your insurance

· An In Network provider (one contracted with your insurance) is obligated by contract to refund you if you overpaid. Contacting your insurer for help usually yields immediate results. In my experience, refunds are issued quickly after a conference call with the insurance’s representative.

· If a provider still refuses to refund, file a complaint with your insurance and/or your State’s Attorney General.

In conclusion:

“Good accounting makes for great friends”. This goes for your medical practice. You should be able to trust the billing staff as much as you trust your Dr or hospital. And trust is built on cooperation, communication and transparency.

Martine Brousse, the "medical bill whisperer" is a Patient Advocate and Certified Mediator located in CA and the founder of AdvimedPro, which she started after 20 years as a billing manager for physicians. - - (424) 999 4705 - F (424) 226 1330

@ Martine G. Brousse 2023

@ The Medical Bill Whisperer 2023

the 411 on refunds to patients
the 411 on refunds to patients

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