We are a medical practice being hit hard by retroactive disenrollment refunds. Insurance pays claim then months/years later they send a letter asking for total refund due to coverage cancelled prior to services. We always verify benefits on all patients 2 days prior to visit. The insurance company defense is they did not update their system in time. Can we hold the insurance company liable, since we were given wrong information, had there been no insurance, money for visit/surgery would have been received prior to services from patient. Is there a time frame in the state of PA for an insurance company to request a refund; how far back can they go? You assistance is appreciated
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This sounds very complicated and involved. I would get a lawyer that specializes in health insurance law. Your problem probably can’t be answered on a law question and answer site like this one.