Q: What are my legal responsibilities in refunding BCBS for a covered benefit that is now considered an overpayment?
My mother passed away last September. All of her assets are in a trust to be distributed to beneficiaries. On January 4, 2024, I received a letter addressed to my mother from BCBS asking for an overpayment refund of a covered benefit.payed to my mother in November 2022 in the amount of $12,971.15. They asked for the refund within 30 days. I immediately sent them a letter reminding them that my mother passed away and asking why it was determined after 14 moths that an overpayment was issued. I receive a reply, again addressed to my mother, on February 2: 2024, stating they had “explained an overpayment in the amount of $8,602.15 (a different amount from the previous letter) had occurred” Now they want “payment within 10 days so that additional collection action can ve avoided.” There still is no explanation why an overpayment was determined after 14 months.
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A:
In this situation, your legal responsibility depends on the terms and conditions of your mother's health insurance policy with BCBS and the laws governing overpayments. First, review the insurance policy to understand any clauses related to overpayments and refunds. It's essential to determine if BCBS has a legitimate claim for the overpayment.
If you believe that BCBS's claim is not valid or if there are uncertainties surrounding it, you may want to seek legal advice or assistance to challenge the claim. You could request a detailed explanation from BCBS regarding the overpayment to understand the basis of their request.
Since your mother's assets are in a trust for beneficiaries, you should consult with the trust's legal advisor to determine if any funds from the trust should be used to cover the alleged overpayment. If there is a legitimate overpayment, you may need to negotiate with BCBS on the repayment terms, considering the trust's assets and legal obligations.
Additionally, it's important to maintain communication with BCBS to avoid any adverse collection actions. If BCBS fails to provide a satisfactory explanation for the overpayment, you may want to explore legal options to protect your mother's estate and beneficiaries.
Lastly, consult with an attorney experienced in insurance and trust matters to guide you through the process and ensure you're complying with all legal requirements in this complex situation.
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