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What are insurance clawbacks? ?Insurance clawbacks? describe when a third-party payor (usually an insurance plan) requests repayment of funds it initially paid to underwrite a service. Clawbacks occur when the payor later determines that the service was not covered.
Historically, the state of Illinois, like many states, implemented a ?payback? or ?clawback? provision that allowed it to seek reimbursement from ABLE accounts after a beneficiary's death.
In a practice known as clawbacks, insurers can recoup money after determining they've paid too much on past claims due to incorrect coding or fee-for-service reclassifications. Some enlist third-party companies to find overpayments, even if they occurred years ago.