Can a health insurance company reopen and then deny a claim after it has already been processed and paid out?

Other answer:

You leave employment on November 30 and go to the doctor on Dec 1. The insurance company won't know that you're eventually going to be dropped effective November 30, so they pay the claim. Later when they are notified, they reprocess the claim as denied since you weren't covered.

It has nothing to do with fraud (necessarily).

Yes, it can do so, if an error was made by paying the claim in the first place. Your insurance only covers what the policy indicates. If a payment was made in error, the insurer is fully allowed to reverse the payment.
if they eventually find that the claim was fraudulent, it very well could be reopened and addiitonal charges made sudh as insurance fraud–not a good thing to be charged with
Yes. An insurance claim can always be reprocessed if new information becomes available.
Casey Y:
Yes, they can – if they get additional information that they did not have at the time they first processed the claim.
A Hunch:
If there was fraud involved = sure.
Only if fraud is detected.

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