"Claim overpaid" how does this happen?

When I see a provider sometimes I'll pay a co-pay upfront, sometimes I'll pay nothing upfront, but when health insurance processes claim they will let me know what my patient responsibility is, and so I will pay that.

I have several claims (with different providers) over the last year where a claim was processed, I was told I'm responsible for some payment, I make the payment, and then months later I will see that I overpaid, and I should reach out to the provider to confirm the amount that I owe.

I've never hit my deductible so it's not related to that.

How is it that the heath insurance company processes a claim, and months after payment is made the situation changes.

What new information could possible happen between a claim being processed and me making a payment to lead to this outcome?

I know U.S. healthcare system is overly complex, but I'm still surprised that this happens.

One provider was for PT, that I saw multiple times, and for the same treatment my insurer is saying some I'm responsible for, and some I'm not (I think there is a limit for PT services per year but I did not even come close this this).

I've tried asking insurance company directly, but they do not seem to have any information that they can share.

submitted by /u/mxdalloway
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