INSURANCE COMPANY PAID FOR GUY’S SURGERY, THEN SAYS IT WAS A “MISTAKE” & ASKED HIM TO PAY BACK
Insurance company asked for refund. What do I do?
I am a current uni student and have been diagnosed with a medical condition which requires me to undergo surgery recently.
For my surgery, I previously asked for pre-authorisation from my medical insurance but initially due to not having sufficient documentation from my attending doctor and some confusion from the insurer’s part, the pre-authorisation didn’t go through and so I went for my surgery without the backing of my insurance.
After my insurance I sought for another letter from my attending doctor and this time they approved the claim and paid me back the money for the surgery.
But a week later, the company suddenly emailed me and asked for a refund citing that they have paid me “mistakenly” and the reason was my treatment was under an exclusion clause.
For context, I have a previous medical history of an endocrine condition that is completely separate and unrelated to my surgery, and unfortunately treatment for the endocrine condition was excluded under the policy.
I think it was because this endocrine condition was detailed in my doctors letter which have made them mistakenly think that I was seeking to claim for my endocrine condition.
After clarifying with them that I was claiming for surgery and NOT my endocrine condition they still insisted that I refund them the money while they continue to ‘investigate’ and I just got really worried whether insurance companies are allowed to demand money back from people anytime after the claim was approved and whether they have the right to do so (meaning if I ever get another surgery would they suddenly ask for a repayment a few years later???).
And also possibly wondering why they approved the claim if it was not finalised and then demand for the sum back.
The issue i have now is I don’t come from a well to do financial background so while to the insurers and most redditors here I believe it rly is not that big of a sum of money, I immediately used a large portion of the sum to offset my surgery fees when they transferred the sum to me .
Little did I know that situations like an insurance calling for a refund is even possible. After speaking to others they told me that debt collectors (??) may come after me if I don’t pay up as soon as possible or even get myself into a possible lawsuit??
So I am now really anxious if that will really happen and in the mean time I’m trying to get the sum back as of now.
Sorry for the lack of knowledge here as I am rather new to insurance policies. Is there any official outlet or ministry I can contact for help about this? Thanks for the help in advance!!