Group and Individual policy- COB

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Posted: Fri Nov 19, 2010 4:49 am Post subject: Group and Individual policy- COB

I'm in Colorado and recently had a baby. I had both a group and individual policy throughout the pregnancy. The hospital has issued me a refund check for overpayment of our bills, stating that both insurances paid as a primary insurance and are refusing to see that the other exists. They are telling me that this is a benefit of having both a group and individual policy and that there is no COB clause on the individual policy. The individual policy company has refused the refund. Is there a statute of limitations as to how long they can come looking for this money? Is it ours? Any help is appreciated. _________________ Register Now to have your Insurance queries solved.

dearkate

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Posted: Sat Nov 20, 2010 1:20 am Post subject:

Quote:

They are telling me that this is a benefit of having both a group and individual policy and that there is no COB clause on the individual policy.

While it's true that there is no COB provision in an individual policy (because people normally don't have two), your individual policy should still be considered primary (because you probably pay more in premiums for it). For the group policy to have paid the same claim in the same manner, that's where the "problem" lies.

Technically, the money is and is not yours. If it's in your hands, obviously it's yours. But it really should not be there. You haven't said whether you've contacted the group insurer. See if they want the money back. If they don't then you can chalk this one up to the inefficiency that Congress has claimed exists in health insurance.

Use the money for your child's education in that event.
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