How to Defend Against Insurance Company Recoupments, Repayment Demands, and SIU Audits

Out of network (OON), providers keep facing recoupment, refund demand, and so-called special investigations (SIUs) from insurance payers and health plans. If you are an out of network provider, it is imperative that you balance bill your patients for the difference between charge and payment. The Webinar will discuss what recoupment and audit are, the reasons that insurance companies state are the reasons for the overpayments, and what steps should be taken to defend against the insurance company’s overpayment demands.  The Webinar will address the ERISA obligations and protections and the importance of a provider obtaining a valid Assignment of Benefits. It will also set forth the notifications which must be sent out by the insurance company when it conducts an audit and seeks recoupment.  

Sign up for this 60 min Webinar where industry veteran Thomas J. Force, ESQ. will discuss the concept of full and fair review and that recoupment demands are considered “adverse benefit determinations”.  He will advise the attendees of what information they are entitled to so that they can respond to and defend the audit findings and recoupment demands. Thomas will also discuss various court cases on these issues and the most common basis for recoupments, such as services not covered under the plan or non-compliant.

Webinar Objectives

After attending this webinar, participants will learn:

• How to respond to an audit and refund demand by never refunding money without demanding a written explanation for the recoupment.
• How to respond to an audit and refund demand by verifying its accuracy.
• How to object to a recoupment in writing.
• About relevant court cases. 
• How to make written ERISA Demands in objection letters.
• What to do if the insurance company does not comply with ERISA demands. 
• About relevant state insurance laws. 
• The time frames for seeking recoupment.
• About the importance of obtaining a valid and enforceable AOB. 
• About mandatory information which must be provided to them during an audit.

Webinar Agenda

• How to Defend Against Insurance Company Recoupments, Repayment Demands, and SIU Audits
• What is Recoupment?
• Characteristics of Recoupment Letter
• Understanding Basic ERISA Obligations
• Full and Fair Review
• Recent Court Cases
• Importance of obtaining Valid and Enforceable AOBs
• When faced with a Recoupment
• Unsupported Services
• Interplay with Insurance Law
• Are ERISA Demands are Not Met
• If the Insurance Company Does Not Comply with ERISA Demands

Webinar Highlights

• What should be done when a provider receives an audit or overpayment demand,
• How to object, appeal, hire an expert, and make document requests. 
• The state insurance laws regarding time frames to request recoupments. 
• What happens when the insurance company does not comply with the ERISA demands.

Who Should Attend

• In and Out of Network Providers
• Medical Billing Companies
• Providers’ Office Staff
• Physician, Facilities
• Healthcare attorneys