BCBSIL Recoupment Update: DOI Complaint Template for Recoupments Beyond 12 Months
The ICS continues to hear from members who have had payments recouped by BCBSIL via “offsetting.” As many of you know, this occurs when a payer unilaterally takes back its previous payments to the doctor by keeping claim payments owed to the doctor for other patients. BCBSIL has issued electronic remittance advice (ERA) documents to many of our members to notify them it has taken back previously paid claims via these offsets.
The ICS initiated legislation in 2010 to put a time limit on allowable recoupment, and the Illinois Insurance Code, 215 ILCS 5/368d(c), now restricts recoupments to within 12 months after the original payment was made. However, in cases that members have brought to the ICS’ attention, BCBSIL is taking back money from payments made prior to the last 12 months, some even going back years.
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The Illinois Department of Insurance declined the ICS’ request for a meeting to address the issue, but suggested that we encourage members to file individual DOI complaints. DOI has said that this would give the agency the opportunity to thoroughly investigate the specifics of each instance, while gathering the documentation needed to address not only the complaint received, but also any other issues that might arise during the course of the investigation.
The DOI advised that the easiest and most efficient method to file a formal complaint is online through the following link: IDOI Help Center. There are also printable complaint forms available on the site, if needed. The agency asks to allow four to six weeks for completion of the investigation, at the conclusion of which they are to provide a written explanation of their findings, as well any corrective action being taken.
The ICS strongly urges affected doctors to file complaints, because we are looking to DOI to render an opinion that Illinois law, including the 12-month “takeback” limitation, applies to insurers and third-party administrators, because it is related to their network provider contracts. We have prepared a template complaint here that members may tailor to their facts and can copy and paste into the DOI Complaint form. Bringing your complaint to the Department of Insurance is a direct and efficient way to seek enforcement of the recoupment law, helping both you and your profession.
For information on how to de-identify patient records, see: How to De-Identify Records
For detailed instructions on filing a DOI complaint, see: Filing a Complaint with DOI
For general information on time limitations on recoupment demands, see: Time Limitation on Recoupment Demands.
