We have identified the following overpayment and are in good faith voluntarily refunding all monies collected in error. Contact My Office And Take The First Step Toward Resolving Your Issue.Please download the form, complete each field and print. Include the form with your refund so we can properly apply the refund and record the receipt. Ethically, you might feel obligated to inform them about the overpayment. Legally, however, it can vary. Refund and Overpayment Reporting Form. Address: Memorial Hermann Health Plan. This Bill of Rights is a summary of your rights and does not become a part of your policy. The Texas Department of Insurance (TDI) adopted the Bill of Rights.

Overpayment Letter To Insurance Company In Houston

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