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.