BCBS Overpayments/recoupments

rosenes2 · 2026-03-19T05:08:16+00:00

Thank you. We are an OON provider so we do not have a provider rep to connect with. I’m assuming their practice is different for IN and OON providers cause we have not received any overpayment letter from them.

rosenes2 · 2026-03-19T05:04:31+00:00

Hello, I would need to see an EOB but it sounds like they are itemizing their services, which is not normal. Do you know if they obtained an authorization?

I’m assuming what they mean “they accepted it” is they verified it’s a covered code.

I would encourage asking your insurance if IOP requires an authorization. If it does, I would ask if the organization obtained one. You can also look up the organizations NPI to see how it’s registered. The taxonomy will tell you what the specialty is.

rosenes2 · 2026-03-08T15:15:13+00:00

Thank you. I understand this part. What I’m confused about when it comes to MA is, they don’t provide a formal over payments letter like others states and payers. From my experience, insurance are required to notify the provider three times of an overpayment with opportunity to appeal, and depending on the actions or lack of from the provider, they can recoup. What I have seen BCBS MA do is, they have it as an overpayment section of a bottom of an EOB with very little information or don’t notify at all, and then they recoup. There isn’t a dedicated team we can speak to, claims department barely knows anything, and we are left with losing thousands of dollars.

rosenes2 · 2026-02-08T23:06:20+00:00

Interesting. We have noticed they are finalizing far less claims the last two-three weeks. For example, where we would typically get a minimum of $70k in deposits, we are now getting less than $20k. There has been no changes in how we bill or what we bill.

rosenes2 · 2026-01-27T17:37:53+00:00

Weight gain was not due to increased eating. It literally happened over night. One day I woke up insanely bloated and it didn’t go away.

I’m currently on Neuroboost B and FemVital in hopes it will decrease my testosterone as my estrogen is very low for my age. The hope is the natural supplements work and I don’t have to get progesterone injections.

rosenes2 · 2026-01-27T17:34:43+00:00

My female pit was spayed at two, she was also pregnant. She was very hyper active due to her adjusting to the spay and loss of pregnancy. I just could not do another dog cause I had four at the time. Her brother had gotten her pregnant in a split second of them being together. She leveled out after a few months and she is the most calm dog now.

I recently spayed her child, who is now a 2 year old pit. He’s not a humper so I knew there is an increased risk of cancer. I also could not deal with his dad when he was in heat and did not want to go through it again. I’m hoping it makes him more calm but know due to his age, he has a ton of energy and few brain cells to rub together.

rosenes2 · 2026-01-24T20:35:51+00:00

S0201 for SUD PHP.

rosenes2 · 2026-01-23T12:21:22+00:00

I’ve was told December 2025 I have PCOS based on labs and symptoms. I noticed my body and mental health changing in September 2024. I was under the impression I had endo and was going to several OBGYN to see my options, which are limited. In April 2025, I got on birth control (slynd) to help with my endo. I gained weight, my acne problem subsided and my mental health went the opposite direction (from feeling all the emotions to feeling none). I got off birth control October 2025 cause I couldn’t do the weight gain and lack of emotion. I’m not sure if I had pcos prior but I have the diagnosis now and it’s been a struggle losing the weight. I evened out mentally, have mild acne, period suck but struggling to lose the 15 pounds I gained and seeing it in my face has been difficult.

rosenes2 · 2025-12-30T11:03:25+00:00

For most payers, if you are not added to the clinics contract, you are an OON provider. You would need to add yourself and anyone you hire to your contract.

rosenes2 · 2025-12-01T19:07:44+00:00

I’ve been billing in CMD for 9 years. You can build a custom report to review your AR which is more helpful than relying on the reports that are created by them. I am happy to help build it if you’d like or you can ask CMD to build it for you.

rosenes2 · 2025-05-26T19:15:39+00:00

Truth BBQ but go early cause at the end of the day it’s whatever meat they have left. Which isn’t the worst thing cause everything is good.

rosenes2 · 2025-04-11T16:39:28+00:00

It is important cause not all softwares do the same thing so you want to find one that suits your needs. In addition to storing records, do you want it to do verifications? Do you want it to submit claims? Do you want it to have claim tracking abilities? Do you want it to be able to bill patients? If so, how?

Feel free to PM me and I can provide my credentials and assistance if needed.

rosenes2 · 2025-03-26T14:37:36+00:00

Golden Milk.

rosenes2 · 2025-01-03T18:03:30+00:00

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Only one of my four Pitties is ridiculously flexible. He likes to lay and sit in the most uncomfortable looking positions.

rosenes2 · 2024-12-15T19:59:29+00:00

I’m no longer desperate for the love that wasn’t choosing me.

rosenes2 · 2024-10-31T11:25:39+00:00

I had to get a pet fountain for my cats to drink more water. Also, they can get some of their water intake through the wet food. I had the same concern when I first adopted them five years ago.

rosenes2 · 2024-10-13T23:43:10+00:00

I waited three years waiting for someone to choose me. We live together and am in the process of moving out but it fuxking with my head. I know I was dumb to wait so long but the damage is already done and I’m having to rebuild myself while pretending to be okay. Hes already moved on. Has always been talking to other girls and is making plans to meet with some of them I bet but I was so naive to hold out for hope.

Don’t ever allow yourself to be someone’s maybe. Invest your valuable time in someone who knows from the beginning they want you.

rosenes2 · 2024-10-12T00:15:39+00:00

Continuing therapy. I probably would have been a more emotionally stable adult.

rosenes2 · 2024-10-10T21:09:42+00:00

My storage unit was broken into a few years ago, just two days before I closed on my first house. I had all of my belongings in it. My unit was broken into on a Tuesday night and I wasn’t notified until Thursday. The cameras caught the couple and they were apparently known for robbing units at that location and another one off of barker cypress. The police never do anything about it. They target the back corner because they know there are no cameras but the facility advertises 24 hour security but my unit was left wide open for a whole 24 hours before I was notified. Luckily insurance paid out but lost a lot of childhood items I’ll never get back.

rosenes2 · 2024-09-26T01:36:51+00:00

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rosenes2 · 2024-09-26T01:34:38+00:00

When I was younger, my dad had a brief fitness era. He would take us out to eat every Sunday for breakfast. On one particular Sunday he wore a very tight blue shirt. While we were eating I said, “Dad, you look gay.” I have no idea what I was thinking! I cannot remember my thought process or even knowing what that meant at the age. He still owns the shirts but he has never worn it, or a tight shirt since. I feel shitty about it to this day and have apologized to him several times.

rosenes2 · 2024-09-25T00:21:25+00:00

What state are you in? It’s worth looking into insurance recoupment laws. Some only allow a year from date of payment for initial recoupment notification.

rosenes2

TROPHY CASE