Pennsylvania Statutes Title 40 Pa.C.S.A. Insurance § 3804. Exceptions to retroactive denial of reimbursement

(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.