Payment Recoupments for Private Option Patients

AMS has been notified of Blue Cross Blue Shield issuing letters of recoupment to several physicians involving Private Option patients.


As you know, the Department of Human Services has been conducting a revalidation process for patients covered by the Private Option.  For many patients, this process has been delayed due to circumstances beyond their control.  Delays in entering information into the DHS system has caused these patients’ coverage to be terminated.


DHS has notified insurance carriers with Private Option enrollees about these coverage terminations and of the DHS plan to recoup from them the portion of patients’ premiums paid by the State.


Consequently, AMS would like you to know that recoupments from Blue Cross Blue Shield, or any PO insurance carrier, may not be the carrier’s fault, but due to information provided by DHS.  AMS is working with both DHS and the carriers to find a way to avoid further recoupments.


AMS will provide new information as it becomes available.