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Ed Turner
Ed Turner,
Category: Law
Satisfied Customers: 2775
Experience:  Director and Consultant Solicitor (Self-Employed) at Ed Turner LLB Limited
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I am an indep medical provider - BUPA are trying to recoup

Customer Question

I am an indep medical provider - BUPA are trying to recoup payments made since 2019 to me as they feel they were overpaid - i disagree and they have a billing system that rejects invoices at the first point - where do i stand
JA: Where are you? It matters because laws vary by location.
Customer: Hertfordshire - my practice is in London
JA: What steps have you taken so far?
Customer: I have sent them an overview of each charge - they say they didn't receive all of them - but have now - and my reasons for billing
JA: Is there anything else the Lawyer should know before I connect you? Rest assured that they'll be able to help you.
Customer: not that i can think of - it amounts £3,839
Submitted: 20 days ago.
Category: Law
Expert:  Ed Turner replied 20 days ago.

Hello. I am Ed, a Solicitor qualified in England and Wales with over a decade’s experience in the legal profession advising clients.

I specialise in Commercial Contracts, Business Transactions, Employment, Dispute Resolution, Personal Injury and Road Traffic Law and shall be reviewing your legal problem today.

I shall be delighted to talk with you by phone to discuss your issue in greater detail if you accept the site’s automatic offer of a Premium Service Phone Call.

Expert:  Ed Turner replied 20 days ago.

I am sorry that you are facing a potential dispute with your health insurance provider over them attempting to recoup alleged over payments but hopefully I can assist you in resolving the matter before it escalates and you are forced to incur significant further legal costs.

Customer: replied 20 days ago.
are they able to do this?
Expert:  Ed Turner replied 20 days ago.

Yes, if they can prove that they have overpaid you.   It will be in their policy wording.

Expert:  Ed Turner replied 20 days ago.

Have you terminated your policy with BUPA?

Are you still paying Premiums to them?

Customer: replied 20 days ago.
im the provider - I have given treatment to their clients and they paid me but now they feel they over paid and want to recoup the monies - i have an evergreen contract with them and the patients had pre auth treatments
Expert:  Ed Turner replied 20 days ago.

Have your proved to BUPA that the payments are correct?

Expert:  Ed Turner replied 20 days ago.

You must deny the claim on the basis that BUPA has incorrectly calculated the payments and that they have paid you the correct amount.   Therefore, the failure is on the part of BUPA, and you are not liable for the amount claimed.

If BUPA claims the monies as a debt, you must deny the debt and state the monies claimed are a disputed damages claim.   BUPA will have to issue contested Part 7 Court Proceedings for damages for debt and/or breach of contract plus interest and legal costs as opposed to following the undisputed debt recovery route of serving your company with a Statutory Demand for repayment in the debt in full within 21 days prior to filing a court petition a Compulsory Winding Up of your company.

Thereafter, you are in a bit of a tricky spot. If you refuse to pay up, the supplier may pursue you for damages through the Civil County Courts. However, the onus will be on the Claimant to enforce their legal rights against you. Whether or not they take any action is up to them. I cannot advise you directly upon whether the Claimant will in fact take any recovery action against you as I do not know what is in their minds.

In addition, the amount claimed of £3,839 is comfortably within the Small Claims Track threshold of £10,000 damages.   Even if the Claimant issues Court Proceedings against you for this amount, plus interest, and wins at a fully contested Trial, they are unlikely to be awarded their legal adviser’s costs of the Claim.     Legal advisers’ costs are generally not recoverable in the Small Claims Court: only Court fees for issuing the Claim and for the Final Hearing.

Nevertheless, the Claimant may be well-versed in such low-value recovery action against defaulting customers or may be able to instruct legal advisers for a low fixed fee to litigate the entire Court Proceedings on its behalf making it economic to claim against you.

I suggest negotiating a settlement of the claim on mutually agreeable terms with the Claimant.

Expert:  Ed Turner replied 20 days ago.

I hope this is a satisfactory initial reply to your question and you understand my recommendations. Please revert to me if you do not understand anything and require clarification of my answer and I shall be delighted to assist.

I can also offer a Premium Service Consultation for an additional fee if you need detailed and bespoke legal advice. If you accept, I will pass you my direct email address and phone number. I can review any relevant documentation and consult with you by telephone for around 20 minutes. This will give you a clearer picture of your legal position and your potential options for progressing the matter to the next stage.

Kind regards

LawyerEd

Expert:  Ed Turner replied 20 days ago.

I hope that you are satisfied with my reply and wish you all the very best in resolving this matter.

If you require further legal advice from me, please create a new text thread on the portal and start it with @EdTurner. I will be notified of your request and prioritise it.

Kind regards

LawyerEd

Expert:  Ed Turner replied 20 days ago.

I hope that you are satisfied with my reply and wish you all the very best in resolving this matter.

If you require further legal advice from me, please create a new text thread on the portal and start it with @EdTurner. I will be notified of your request and prioritise it.

Kind regards

LawyerEd