HC.gov Problems Persist

[RayNY]

Now all my Humana clients in MS are coming back to me saying "My Dr said he isn't taking that insurance"...

Most irritating part is that I checked each provider before I set the client up with that coverage..

Are the doctors "not taking obamacare" or are they specifically not taking new patients/not participating in that network and carrier? Carrier provider searches are usually pretty accurate.

I call providers daily that deny my clients' "obamacare". I tell them, "it's not obamacare, it's XYZ plan with ABC network from Humana, and you participate with Humana and the ABC network, correct?"

They say yes, I say to accept my client, and they do. If they don't (Which is rare), I just tell them that willful and baseless denial of an eligible insured is grounds for contract termination with the carrier. (True or not, I don't care, just accept my damn client.)

Not even joking, literally every day I do this. It's getting old fast.

 

[kgmom219]

Are the doctors "not taking obamacare" or are they specifically not taking new patients/not participating in that network and carrier? Carrier provider searches are usually pretty accurate.

I call providers daily that deny my clients' "obamacare". I tell them, "it's not obamacare, it's XYZ plan with ABC network from Humana, and you participate with Humana and the ABC network, correct?"

They say yes, I say to accept my client, and they do. If they don't (Which is rare), I just tell them that willful and baseless denial of an eligible insured is grounds for contract termination with the carrier. (True or not, I don't care, just accept my damn client.)

Not even joking, literally every day I do this. It's getting old fast.

So glad I'm not the only one doing this. 2 yesterday. 3 on Monday. I am following up with an email to my rep, who is sending it on to provider relations. I asked my pediatrician yesterday (one of the docs offices I had to call for a client) and they told me that they received a call from their provider rep 24 hours after me. Which made me feel a little better!

 

[Tkruger]

In the sale process if the client has/had a Dr that they were partial to I'd always look it up before i would offer that product. I never sorted a client out with a plan if their Dr. wasn't in network unless after a long discussion that was something that they were "OK" with.

This being said, I'm seeing a trend with MS clients specifically whom I know that I've checked Dr. even double and triple checked only to have them come back and tell me Dr. X says they won't take my insurance. One client even went thru Humana direct after being denied and Humana verified that the Dr. was in network but the Dr. office wouldn't hear it. As I gather more data today from the numerous calls I have to make I'll share it with everyone here.

***Update***
Records show that the Dr. does accept the coverage, Humana shows that they accept the coverage even Medical grades shows they accept the coverage. However a brief call into the Dr. X office yields a no we don't accept it, period. I pressed a bit asking then why do all the records show you do? That was met with you'll need to call tomorrow when the insurance clerk is in...

 

[somarco]

You might want to factor in the 90 day grace period for subsidized plans. Seems quite a few docs are either refusing to take new patients if they have a subsidized plan or are saying the next available appointment is the day before you turn 65.

 

[FLM2]

Looks like mack daddy is finally hooked on the CSR / APTC gravy train..............yeehaw

I must have turned away at least 50 subsidy eligible people during AEP and have lots more that extended their plans another year. It looks like the insurance companies are going to term these policies at the end of the year or at renewal so it would be nice to have a subsidy option for them.

 

[Tkruger]

somarco I'm not sure what you mean by the 90 day grace period. The only grace period information I am aware of that pertains to 90 days is the non pay grace period. This being said I'm unclear as to what you're eluding to with you suggestion.

Please share....

 

[Yagents]

The first 30 days of non payment, the insurance company still has to pay out claims to providers.

Days 31 to 90 of non payment grace period, the providers are on the hook as insurance companies are and will not pay out claims to providers.

Few doctors will see a subsidized patient without payment up front in full during this grace period, if they were a smart business owner, knew of the grace period fiasco, or have a full time staff member calling to confirm paid through date.

 

[RayNY]

Somarco is referring to the fact that providers don't want to see subsidized clients (very generally speaking) because of the 90-day grace period.

Specifically, days 31-90 they must treat the patient and can submit claims to the carrier, but if premium isn't paid, it's on the provider to chase the patient down for the money.

Realistically, there is no way to know how far lapsed a given client is, so they just deny everyone who may be subsidized, and that might be a factor in your scenario.

EDIT: Yagents beat me, but we're on the same page.

 

[Yagents]

Ruh Roh............who didn't see this coming?

Data discrepancies in health care signups affect 2 million people

Data discrepancies in health care signups affect 2 million people

A government document provided to The Associated Press says more than 2 million people who got health insurance under President Barack Obama's law have data discrepancies that could jeopardize coverage for some.

Two million people works out to about one out of four who signed up, creating a huge paperwork headache for the feds, and exposing some consumers to repayment demands if they got too generous a subsidy—or even loss of coverage.

The administration says it is triple-checking consumer information to ensure that only those who are legally entitled to health care subsidies are getting them, and that they are receiving the correct amount.

House and Senate lawmakers are also looking into the data issues, which involve not only income, but citizenship, immigration status and other factors.

 

[Tkruger]

I understood the implications associated with the 90 grace period. Thanks to everyone who reiterated. However, in each case noted clients are paid to date, and Dr. are showing up in multiple ways associated with a particular carrier accepting that particular plan and participating in that particular network. Oddly enough, in half of the cases I've encountered the network is the same both on and off exchange for that area. Figure that bit out....