by bobbybob0123456789 » Wed Dec 12, 2012 05:13 pm
My health insurance company called because they accidentally paid both the out of network vendor AND me for durable medical equipment. They want their money back- am I obligated to pay them back for their error?
Posted: Thu Dec 13, 2012 04:12 pm Post Subject:
Let's see if we can make this more clear to you. You cannot collect twice for the same loss. When the DME vendor was paid, you collected once. When the insurance company paid you for the same bill, you collected twice. You owe one of those two payments back to the insurance company.
Here's another example you might understand.
You ask the bank teller ("CSR" today) for $20 cash. They inadvertently hand you $40. They discover the mistake an hour later, and ask you for the extra $20 back. Who is responsible for the error?
YOU ARE. You got something to which you were not entitled, so, legally, you must return it . . . if they ask. Now, if the bank doesn't ask you for the money back, can you keep it? That's a moral (right or wrong) question you have to answer for yourself. Ethically, you should give it back (morals develop out of ethics, so ethically, you have no entitlement to the money, and should never have accepted it). But maybe you believe that the bank can afford it -- after all, their vault is full of $20 bills, and they won't miss one, will they?
You cannot keep the money for the DME simply because the insurance company made a mistake and paid two persons for the same claim. Technically, knowing that you received payment for a claim to which you were not entitled, you are committing insurance fraud, which could cause you to go to prison if you were convicted.
Pay the insurance company what you owe them. If you don't, guess what, they can take the money back from the DME vendor. How do they really do that? They deduct it from the next claim they pay to the DME vendor, with the explanation, "We paid bobbybob0123456789 for that, so we should not have paid you. He owes you the money. Get it from him."
Can you refuse to pay the DME vendor for the merchandise you have received? Of course . . . you can do whatever you want, but that doesn't make it right. Then you will find yourself being sued in small claims court by the DME vendor, and you will lose.
Posted: Mon Dec 17, 2012 05:20 pm Post Subject:
Thank you for your response MaxHerr. You are right- and I know it's the right thing to do to pay them back. The reason I had a question on this is that I feel like this is my only "leverage" to resolve an issue with the insurance company about not covering the same type of DME. They covered the first one, but are not covering the second one because the vendor I want to use is not approved. The second vendor provides a better product than the first one- and the insurance company paid for it, but will pay nothing for the second one. I wanted the insurance company to work with me on this, but they aren't.
I will need to handle that separately as I really need to take it up with the vendor not being approved.
Thanks again.
Posted: Tue Dec 18, 2012 12:22 am Post Subject:
They covered the first one, but are not covering the second one because the vendor I want to use is not approved.
This is a completely different issue and is not at all related to your original post. You cannot hold the insurance company hostage, so to speak, over its non-payment to a nonapproved vendor. You are required to use your insurance according to the terms of your contract.
It doesn't matter that a nonapproved vendor has a better product, or a less expensive product. The vendor is not approved for other reasons -- or has chosen not to be approved by your insurance company.
I wanted the insurance company to work with me on this, but they aren't.
If you get your insurance at Burger King, then you can have it your way. Until then, the only rules of the game are those written by the insurance company, and you are not the referee.Add your comment