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Recovery of Excessive Payments

Provider Type

  • Physicians
  • Participating Physician Groups (PPG) 
    (does not apply to HSP)
  • Hospitals
  • Ancillary

If the amount of the payment made by the plan is more than it should have paid under the coordination of benefits (COB) provision, the plan may recover the excess from one or more of those it has paid or from any other person or organization that may be responsible for the benefits or services for the covered person. The amount of the payments made includes the reasonable cash value of any benefits provided in the form of services.

Last Updated: 10/30/2019