Legal Question in Insurance Law in Wisconsin

Repayment of insurance money paid to me.

Several times our health insurance company has done an audit at the end of the year or even a couple years later. They will then say they 'errored' in a payment to us or our doctor and want it back. I got another such letter yesterday demanding a large sum supposedly paid in error to our oral surgeon. Do we always have to blindly send money back? They always include a threat if not paid back promptly. What are the consumers rights or is there a time limit on these error audits in Wisconsin? The demanding letter I received yesterday actually came right from a collection agency hired by the insurance company to look for errors! Thank you.


Asked on 12/21/05, 9:03 am

1 Answer from Attorneys
Frank Pasternak Pasternak & Zirgibel S.C.

Re: Repayment of insurance money paid to me.

Unfortunately, health insurance law is outside my area of expertise. I would however recommend that you review the determination made by the company and then review your health insurance policy. If the company's customer service does not resolve your problem, contact the Wisconsin Commissioner of Insurance.

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Answered on 12/21/05, 2:03 pm


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