Pennsylvania § 3804 - Exceptions to retroactive denial of reimbursement.
Full text of Pennsylvania Pennsylvania Consolidated Statutes § 3804 — Exceptions to retroactive denial of reimbursement., with citation guidance and answers to common questions.
§ 3804. Exceptions to retroactive denial of reimbursement.
The provisions of section 3803 (relating to retroactive denial of reimbursement) do not apply if an insurer retroactively denies reimbursement to a health care provider because any of the following apply:
(1) The information submitted to the insurer constitutes fraud, waste or abuse as defined in this chapter.
(2) The claim submitted to the insurer was a duplicate claim.
(3) Denial was required by a Federal or State government plan.
(4) Services were subject to coordination of benefits with another insurer, the medical assistance program or the Medicare program.
Cross References. Section 3804 is referred to in sections 3803, 3805 of this title.
Source: official Pennsylvania text · Last verified 2026-08-27
Frequently Asked Questions About Pennsylvania § 3804
What does Pennsylvania Consolidated Statutes § 3804 cover?
Section 3804 ("Exceptions to retroactive denial of reimbursement.") is part of the Pennsylvania Consolidated Statutes, the codified statutory law of Pennsylvania. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite Pennsylvania § 3804?
A common citation format is "Pennsylvania Consolidated Statutes § 3804" (Pennsylvania). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of Pennsylvania law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Pennsylvania official source linked on this page or consult a licensed Pennsylvania attorney.
How does Pennsylvania § 3804 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Pennsylvania can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in Pennsylvania.