States setting time limits on insurer claims "takebacks"

At least five states have passed or are considering legislation restricting health plans' ability to demand money back for apparently overpaid reimbursements.

By Julie A. Jacob, AMNews staff. Jan. 28, 2002.

If it weren't frustrating enough waiting for an insurer to pay a claim, some doctors are experiencing the added aggravation of receiving payment for a claim and then years later having an insurer claim that it overpaid and demanding its money back.

That situation is called a takeback, and some state legislatures are trying to make sure that it doesn't turn into a big headache for physicians.

This year, the Florida and New Hampshire legislatures are considering bills that set time limits on insurer requests for repayments of overpaid claims. Those bills are similar to legislation that went into effect last year in Missouri and Utah and that will go into effect in Ohio this July.

Such provisions are already part of state prompt-pay laws in Kentucky and Maryland, according to the AMA's Advocacy Resource Center.

The bills in Florida and Utah also include provisions that require physicians to respond to insurer requests for claims takebacks within a certain number of days. John Knight, the Florida Medical Assn.'s general counsel, said that's only fair.

"It's difficult to argue that an HMO had to pay the insurers in 35 days, but the physicians didn't," Knight said.

The trend toward states limiting the time in which insurers can request repayment of claims overpayments and the time in which physicians must respond to such requests indicate that state legislatures "are trying to be fair and address [the issue of claims payment] from both sides," said Rachel Morgan, a policy associate with the National Conference of State Legislatures' Health Policy Tracking Service. [...]