The Physician's Risk in HCR

[Yagents]

You may have insurance, but it does not mean a doctor will see you. Health care dichotomy coming for exchange buyers?

Health exchanges could bring unpleasant surprises*:*Family Practice News

A little-noticed provision of the Affordable Care Act gives exchange participants a 90-day grace period to pay their premiums. This was designed to provide a cushion for people who might not be used to paying health insurance premiums.
Insurers have to pay all claims incurred by the patient in the first month, but in the second month, if the patient is still delinquent, all claims can be held as pending. By the third month, if the patient still has not paid, the insurer can terminate him or her.
The physician then has to collect payment for all outstanding claims from the patient.
"This is going to put you at a lot of risk," Ms. McNeil said. "You're going to have to be very vigilant with the exchange patients in watching what's going on."

 

[HealthGuy]

Yagent this is a very interesting tidbit thanks for sharing!

 

[kroWdraH]

Will this lead to doctors turning people away that are on the exchange?

 

[somarco]

Years ago I would write large group cases (100+ lives) with 90 day grace periods. Never heard of this in the individual market.

What a stupid idea.

Physicians also will need to pay close attention to the contracts they sign with health insurers that are participating in the exchanges.

This implies providers would (could) potentially sign two separate contracts. One with a HIX provider, another with the same carrier for non-HIX business.

 

[taterpeeler]

Bill... Are we sure thi s is in the federal plan or is this just the California plan... Remember, they passed their own tricked up version of the law.... After reading this it appeared its some California provision and no one here has ever mentioned it and wheni read the law I don't recall seeing it but I may have missed it

 

[somarco]

Tater, clicking the link seems to indicate this is in HHS regs . . . presumably buried somewhere in the 15,000 or so pages.

As previously mentioned in Reform Essentials, the federal Department of Health and Human Services' (HHS) decision to allow for a 90-day grace period for non-payment of premiums presents one of the largest risks for providers weighing whether or not to contract with health insurance exchange's qualified health plans (QHPs).

 

[taterpeeler]

Oh wow somarco. That wild... Never saw it before..... Those that know how to play will pay 9 months.... Pmpy still makes sense

 

[Yagents]

The 90 day is the law of the land. It's also the length to avoid penalty tax.

 

[Ann H]

Agreed. This is Federal Exchange legislation and is therefore applicable to all exchanges whether state or FFE.

By looking at Bill's 2nd link Without a grace period fix, the game's afoot - News - California Medical Association, and then clicking that article's first link CMA Reform Essentials: May 23, 2012 - Reform Essentials Archives - California Medical Association, it appears from the table in the middle of the page that claims paid in the 1st month will not be recouped by the insurance companies.

Also, this in only for policies sold INSIDE the exchange, not in the private market.

Doctors must look out for unreimbursed charges, but agents must also look out for commission clawbacks.

 

[AllenChicago]

So...does this mean the government subsidy will arrive at the insurance company each of the first 3 months, even if the client has not paid his share? Just think.. a legal loophole created by the Federal Government that could hurt the Federal Government.