An overpayment to a provider is any payment you make for a service that exceeds what your health insurance deems as your responsibility. Generally speaking, insurance carriers have negotiated discounts for the services charged by providers to your health insurance plan. Any payment you make to satisfy your deductible, co-insurance, or co-payment should reflect this discount.

How could an overpayment happen?

• If your doctor bills you at the time of service, it is possible that he or she is charging you “retail” and not the discounted amount. For charges other than a flat dollar co-payment, you should not pay for your portion of the service until after the claim has been submitted to your insurance plan by your provider, processed by the insurance carrier, and you have received an EOB.

What to do if you have made an overpayment to provider?

• If you discover that you have over-paid a provider for a service, contact your provider and request a refund. If you used your Choice Care Card to make the payment, have the provider reimburse The Choice Care Card™ directly. Second, call us at 888-278-2555 and let a member service representative know that your provider is refunding a portion of the charge.

How do I avoid being over-billed?

• Always wait to make payments until you receive your EOB.
• Check your EOBs diligently. Contact your health insurance company if you have any questions regarding your payment responsibility. 
• If your provider insists on some sort of up front payment, pay only a portion of the amount they are requesting.

Questions: Contact Member Services: 888-278-2555