Claims Payment Policies & Other Information: Retroactive denials
Some claims may be retroactively denied, even after the member has obtained services from the provider. A retroactive denial is the reversal of a previously paid claim, through which the member then becomes responsible for payment.
There are ways to prevent this from occurring. You can:
Notify HealthCare.gov promptly of changes that could impact your eligibility or your premium amount owed.
Submit requested documentation to HealthCare.gov and/or (issuer name) promptly or within time constraints.
Pay your monthly premiums on time
Members may obtain a refund of premium overpayment by notifying HealthCare.gov of changes that could impact eligibility or your premium amount owed and then contacting Customer Service at 855-447-2900. Please note that in some situations, changes to eligibility must be received from HealthCare.gov before the CO-OP can refund an overpayment.