Four Years Later, CCHA Took the Money Back:

A follow-up on insurance clawbacks and the impossible position they create for mental health providers.

I refuse to be silent about this.

This morning, Colorado Community Health Alliance, or CCHA, withheld nearly $900 from payments owed to my practice for current claims. The stated reason was to recover money paid for sessions that took place in 2022.

Those sessions happened.

The services were provided. The clients received care. The work was documented. Our clinicians were paid. CCHA received and processed the claims, and the claims were paid.

I want to be absolutely clear: this was not fraud. These were legitimate services that actually happened and were documented appropriately. We did not knowingly withhold insurance information or bill Medicaid for services we knew should have been billed elsewhere. We submitted the claims using the coverage information available to us at the time.

Now, four years later, that money is being taken back because CCHA later determined that the clients had other insurance that should have been billed before Medicaid.

We did not know about that coverage at the time. We can only bill using the information clients provide to us and the eligibility information available when care is delivered. CCHA apparently did not identify the other coverage before paying the claims either. Yet FOUR years later, the entire financial consequence is being placed on the provider.

There Is No Realistic Way to Recover the Money

If we had been told in 2022 that another insurer was responsible, we could have submitted the claims to that company. Four years later, that is no longer a meaningful option. Commercial insurers have timely-filing deadlines, and claims submitted years after services were provided will almost certainly be denied.

Many of the clients involved are no longer receiving services from us. Even if they were, attempting to charge a former Medicaid client years later for care they reasonably believed was covered would create another set of ethical and practical concerns.

So CCHA recovers its money, but the practice has nowhere else to turn. The loss simply lands on us.

This Is Not an Accounting Error Without Consequences

This money is not being recovered because the sessions were fabricated, improperly documented or never provided. The services were real. The care was delivered. The problem is that other insurance coverage was identified years after the claims had already been processed and paid.

Nearly $900 may be insignificant within the larger insurance system. For a small mental health organization, it is not insignificant.

That money helps pay clinicians. It helps cover rent, technology, insurance, licensing, administrative support and all the other expenses required to keep mental health services available. It is money we already earned, received and used to pay the providers who performed the work.

CCHA did not ask whether taking it back four years later would affect payroll or our ability to operate. The amount was simply withheld from payments for current services.

Small practices do not keep years of past insurance payments sitting untouched in a bank account in case a payer changes its determination someday. We use that money to provide care.

The Rules Are Not Equal

Providers are held to strict deadlines. We must verify coverage, submit clean claims, correct errors and file appeals within narrow windows. If we miss a deadline, we may lose the right to be paid, even when the service was medically necessary and properly documented.

But when another source of coverage is identified years later, the payer can recover its payment after the provider's opportunity to bill anyone else has disappeared.

That is the injustice.

This is not about asking Medicaid to pay a claim for which another insurer was legally responsible. It is about a system that waits years to resolve coverage, then transfers the entire financial loss to the party with the least power and no remaining path to payment.

If providers are bound by timely-filing limits, payer recoveries involving other insurance should also occur within a timeframe that still allows the provider to bill the responsible insurer. At minimum, a payer seeking repayment years later should be required to provide a viable path for the provider to recover payment for legitimate care.

I Am Tired, but I Will Not Be Quiet

I spent seven years in higher education, followed by years of supervised clinical work toward licensure. I became a mental health provider to help people. I built an organization to make quality care more accessible.

Instead, an enormous portion of my time is spent trying to understand changing insurance requirements, correcting problems we did not create, appealing decisions and fighting to keep money we earned for care that was actually provided.

I am angry because this system is not merely inconvenient. It threatens the survival of the small practices and community organizations people depend on.

Insurance companies and Medicaid administrators may view these recoveries as routine payment corrections. For us, they can determine whether we make payroll, retain clinicians or continue accepting insurance at all.

When providers are forced to absorb the cost of administrative failures they could not prevent and can no longer correct, patients ultimately lose access to care.

So I am going to keep talking about it.

I am going to keep asking why providers face rigid deadlines while payers can revisit claims years later. I am going to keep asking why legitimate, documented care can become unpaid labor long after it was delivered. And I am going to keep calling for rules that do not force small mental health practices to finance failures in the insurance system.

The sessions happened. The care was provided. The clinicians were paid.

Four years later, CCHA took the money back.

That may be permitted under the current system. It is still not fair, sustainable or acceptable.