Can my insurance renegotiate over a year later?
I am in New Jersey, USA.
In January 2023, I had to go to rehab for a shoulder injury. I had multiple visits, paid my bills and copays on time, and paid my balance in full by the end of February. It was about $1,000 due to my copay and deductible.
In May 2024 (a year and three months after my last payment), I received a statement from the insurance company. They decided to adjust my claim. They just sent me a statement with the new numbers. There was no explanation as to why they did this. When I called, they said, "A problem in your account was found in an audit related to the provider." But they told the provider it was related to my deductible. The insurance company's position is clear, though. They say they overpaid the rehab provider by $450, they took the money back from the provider, and now both companies say I must pay the rehab provider the $450.
My question is, why do I owe anything? I have six months to submit a claim, or the insurance company won't take it. Why do they have 15 months to adjust my claim? I received a service, paid their requested rate, and moved on. I don't have the money to pay them right now.
Think about it: I got a haircut in January 2023, too. The hair salon can't send me a bill in May 2024 asking for an extra $5.
Why does insurance get to do this? Has anyone had this happen before? I filed an appeal with both companies to delay paying, but I don't think they care or are even looking into it.
submitted by /u/FlyingDragonRider33
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