Dental Insurance Recoupment Laws

Insurance recoupment laws encompass several key concepts. Firstly, refund requests arising from fraud, misrepresentation, or inappropriate/abusive billing typically fall outside the general time limitations, although it is crucial to consult specific laws for precise details. Secondly, claims involving the coordination of benefits often afford a more extended timeframe for recoupment. Additionally, government entities typically operate within a more extended recoupment window. Lastly, it is noteworthy that numerous insurance contracts establish their own limitations on refund demands. While these contractual limitations may be less stringent than state laws necessitate, they cannot exceed the stipulations mandated by state law. It is essential for stakeholders to be aware of these nuances to ensure compliance within the complex landscape of insurance recoupment.

To Summarize:

  • Refund requests due to fraud, misrepresentation, or inappropriate billing are usually exempt from time limitations; check specific laws for details.
  • Coordination of benefits claims often has a longer recoupment time frame.
  • Government entities also tend to have a lengthier time frame for recoupment.
  • Many insurance contracts set their own limits on refund demands, which may be less than state law requires but cannot exceed it.

If you would like more information on how to manage or avoid refund demands that fall within the time limit, please refer to this article on how to handle dental insurance refund demands.

StateTime LimitOther FactorsSource LawLink
Alabama1 Year18 mo if COBAL 27-1-17Link
AlaskaNo limit-AS 21.54.020Link
Arkansas18 months-23-63-1802Link
Arizona1 year-20-3012Link
California365 days-10133.66Link
Colorado12 months **36 mo if COV w/ federal. No refunds ever if verification of eligibility within 2 business days of DOS.10-16-106.5 and 10-16-704(4F)Link
Connecticut18 months-Section 38a-479bLink
Delaware24 months-CHAPTER 216 2730Link
District of Colombia6 months18 mo if COB31-3133Link
Florida12/30 monthsProvider must respond in 40 days. No response = obligated to refund627-6131Link
Georgia12 months-33-20A-62Link
Hawaii18 months-431:13-108Link
Idaho--No LawN/A
Illinois12 months-215 ILCS 5/368dLink
Indiana2 years-IC 27-8-5.7-10Link
Iowa2 yearsNo refunds under $25 ever191-15.33Link
Kansas18 months-40-2442Link
Kentucky24 months-304-17A-708Link
LouisianaUniqueSame as claims deadline (usually 12 months)R.S. 22:250.34 BLink
Maine12 months-24-A-4303Link
Maryland6 months18 mo if COB15-1008Link
Massachusetts12 months-Bill H.976Link
Michigan--No LawN/A
Minnesota12 monthsunless COB or retroactive termination62Q.75Link
Mississippi12 monthsMax same as claims deadline if lower83-41-219Link
Missouri12 months-376.384Link
Montana12 monthsMax same as claims deadline33-22-150Link
Nebraska6 months-210-60-011Link
Nevada--No LawN/A
New Hampshire18 months-420-J:8-BLink
New Jersey18 months-C.17B:30-48Link
New Mexico--No LawN/A
New York24 months-SECTION 3224-BLink
North Carolina2 years-58-3-225Link
North Dakota12 months-26.1-47-02.3Link
Ohio2 years-3901.388Link
Oklahoma18 months-36 O.S. 1250.2(5)Link
Oregon18 months-ORS 743B.451Link
Pennsylvania24 months-Act 146Link
Rhode Island18 months-27-18-65Link
South Carolina18 monthsExcept for self-insured or state/federal plans.38-59-250Link
South Dakota--No LawN/A
Tennessee18 months6 months if verified56-7-110Link
Texas180 days-1301.1051Link
Utah12 months24mo if COB, 36 month if government31A-26-301.6Link
Vermont12 months-18 V.S.A. 9418Link
Virginia12 monthsMax same as claims deadline if lower38.2-3407.15Link
Washington24 months30mo if COB48.43.600Link
West Virginia1 year-WVC 33-45-2Link
Wisconsin--No LawN/A
Wyoming--No LawN/A

Disclaimer: The information presented in this spreadsheet is intended for general educational and informational purposes only. It should not, under any circumstances, be interpreted as legal advice. Dental Insurance Guy makes no assertions or warranties regarding the accuracy, veracity, or completeness of the information within this spreadsheet and assumes no liability for any consequences arising from its use.

Our Dental Community Sponsors

Resolv logoPatient News logoEdra logoBerman logoPPO logoBasebone logoThe New Dentist logoDental Slang logo