We have identified the following overpayment and are in good faith voluntarily refunding all monies collected in error. The name and ID number of the Member for whom we have overpaid.The dates of service. Contact My Office And Take The First Step Toward Resolving Your Issue. Use this guide to help you and your staff properly assess refund requests from health plans. Overpayment or underpayment. 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. Details we'll need from you: Date of the incident; Basic details of what happened; Names of all parties involved; Insurance information for the other parties. To pursue a claim, use the Claims Form below and follow the instructions on the form.

Overpayment Letter To Insurance Company In San Antonio

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