Can People Start Going to the Dr. Even if They Have Not Received Their Member ID Cards?

[RayNY]

Question comes up 50 times a day, and the only response I can give in good faith is:

"Yes, and you can pay out of pocket, because your health insurance is not in effect until you pay. You can't pay until you are billed, and that will be sometime around the second week of January. If you go between now and then, you should be able to submit it to the carrier for reimbursement, but no guarantees, as this is the first time we're dealing with this new system and no one has a concrete answer of how it will actually work."

I'm not going to sugarcoat it, that's the deal. They're typically not happy, call it BS, and I reply "it's what the American people voted for, twice, and there's nothing our opinions can do about it".

 

[Bob_The_Insurance_Guy]

"Yes, and you can pay out of pocket, because your health insurance is not in effect until you pay. You can't pay until you are billed, and that will be sometime around the second week of January. If you go between now and then, you should be able to submit it to the carrier for reimbursement, but no guarantees, as this is the first time we're dealing with this new system and no one has a concrete answer of how it will actually work."
.

I have said this to both those I've assisted to get a subsidy, and those that I have worked with, directly through the insurance company. The key phrase I punctuate is, " this is the first time we're dealing with this new system and no one has a concrete answer of how it will actually work".

RayInNY, you guys just got a great catcher, and person, in Brian McCann. We will miss him.

 

[RayNY]

Bob,

I drive home the same point, and think everyone should. It's not a "cop-out" answer, it's the most truthful response we can really give. I usually have to say it 4 or 5 times as they ask a bunch of questions that have no answers.

When do I get a bill? "Should be about 2 weeks after the application is submitted, but..."

How long until I get ID cards? "Should be about a week after payment is processed, but..."

How do I know if I'm approved? "They can't deny you and we submitted everything properly and on-time, but..."

etc.etc.etc.

Also, I didn't even know we got a new catcher. The sports I care about involve wheels, not balls.

 

[HelpingPeople]

Yes, they can go to doctor and be covered by their insurance. They may have to put in a claim themselves to the insurance company.

 

[Sherota1]

I wanted to read all of the answers before I posted a reply. Two years ago I had to apply for the PCIP Plan which was part of the ACA because it was the only thing I was eligible for. We also had to submit our applications by December 15, 2010 to be covered by January 1, 2011. I first heard about the program on Suze Orman so I came in a year late.
I met the deadline but because of the year end back log we were told that our coverage would start January 1st but would be retro active. We did have to submit our payment. Once the payment was submitted and processed, any medical bills we received with a service date between January 1st and February 1st were covered had to be submitted to the insurance company. Before that date we had to pay out of pocket setting up a payment plan with the service providers (doctors, hospitals, labs, etc.). Most medical billing departments are willing to work with their clients to set up a plan.
Once I received my card I called my insurance company to find out where to send my bills. I sent in the bills and they covered everthing that was within the plans effective date minus my deductible and sent me a reimbursment check for the excess that I paid above that amount.
Kaiser said their plans will be retro active but that is only effective if you pay your bill and if the clients plan get into the insurance companies system.
They need to call to check on this themselves.Do not rely on a navigator to tell you it made it to the company.
So in a nutshell if things work as in the past you will be covered January 1st. Plans will be retro active. You must pay your premium. You will be responsible for any bills until your account and payment has cleared the system. Keep all bills and all proofs of payment until you receive your plan materials. If you pay online keep all confirmation numbers or print out a receipt. Have the client verify on their own that their application reached the insurance company. Best times to call an hour before lunchtime around 11AM towards the end of the week. If the have a speaker phone put it on loudspeaker and just wait for someone to answer while you do other things.
Hope this was helpful.

 

[sportsinsurance]

I agree with this. But if I am the doctor, I would rather receive cash. Lol! Most insurance agency or companies give the member's ID shortly after they register.

Coverage is coverage. They may be treated as a cash paying patient by the Dr, and then have to submit a claim to insurance company for reimbursement.

 

[Sherota1]

I agree with this. But if I am the doctor, I would rather receive cash. Lol! Most insurance agency or companies give the member's ID shortly after they register.

This is usually true but the companies usually do not receive their customers all at once like what's happening now. There were fewer enrollees for the PCIP and we were delayed 2-3 weeks. After that it got better.
Cash is great for smaller bills like a doctors visit but not for test such as MRI's which can at times be more than $2K depending on where you go a bill that many will not be able to pay out of pocket. It's better to wait if you can but if not be prepared for what you might face financially on the front end before your coverage kicks in. The after that they need to understand what their policy really covers.

 

[wongsk.com]

the insurance policy schedule or jacket will show in the policy. it is best to read the blAck and white instead of going asking around people including your insurance broker or agent.

Insurance policy is WRITTEN CONTRACT.

THANKS

 

[goillini52]

the insurance policy schedule or jacket will show in the policy. it is best to read the blAck and white instead of going asking around people including your insurance broker or agent.

Insurance policy is WRITTEN CONTRACT.

THANKS

I'm going to go out on a wing wong...you're not around here from are you...

 

[wongsk.com]

can i view your medical policy