Author Topic: Horizon BCBS recoupment from 2015 claim payment  (Read 296 times)

Nancyo2

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Horizon BCBS recoupment from 2015 claim payment
« on: November 25, 2020, 12:16:58 PM »
Recently we received an explanation of benefits that included a payment for one physician (surgeon) in practice (recent claim), and a recoupment of payment for another physician (anesthesiologist) in the practice from 7/21/2015! So the payment for the first physician was reduced by $682.46.
I need help! First, is this legal? Can insurance company take recoupment amount from another patients claim payment? Is there a time limit for recoupment? I looked into this matter a little further and the insurance co did send a letter in 2016 asking for return of payment (because surgery was originally denied as not medically necessary but overturned through peer to peer) We thought matter closed since we didn't receive a follow up request. We plan to respond via letter explaining the situation but wanted to get some additional information beforehand.  (providers from New York)

Michele

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Re: Horizon BCBS recoupment from 2015 claim payment
« Reply #1 on: November 27, 2020, 09:02:46 PM »
It is not uncommon for insurance carriers to retract/recoup what they deem as an overpayment from another patient's claim.  I also do not believe they have a time limit.  However, if you do not believe it is an overpayment you can certainly fight it.  I would contact them and ask if they don't show the decision being overturned after a peer to peer review.  It may have been a mistake that they retracted/recouped the payment.
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Re: Horizon BCBS recoupment from 2015 claim payment
« Reply #1 on: November 27, 2020, 09:02:46 PM »