The Physician's Risk in HCR

[AllenChicago]

Is there such a mandate in the ACA? I know that the ACA requires INSURERS to pay claims for the first 30 days of a lapse for subsidized policies in the 90 day grace period. However, I don't remember any mandate for physicians to accept the patient. Of course, network contracts are a different story.

Oh yeah Ann...you're correct. It's insurers who are on the hook during the first 30 days of premium non-payment. But I remember reading something here in the forum about doctor's not being paid at some point... Perhaps it's at the top of this thread. Will have to review it. Thanks!
-ac

 

[RayNY]

Ann,

Even if contracted, nothing compels a provider to service a given patient. They are free to fill up their schedule and not have room, or to decide they have enough patients and aren't accepting anyone new. Really, they can use whatever excuse they feel like.

Heck, there's a whole group of doctors refusing to see anti-vaxers. No other reason, just refusing to see them, even if they're existing patients with valid insurance.

AC,

Day 31-60 the doctor still has to accept insurance as payment (if they choose to see the patient...), but it's pended at the insurer awaiting premium payment. If never rec'd, claim denied and passed back to provider. Day 61-90, the doctor doesn't have to accept insurance as payment, but if they do, it's also pended awaiting payment and then denied if premium isn't rec'd.

 

[AllenChicago]

Can the doctor call the health insurer to find out if the patient is paid-to-date? Or is that protected information that doesn't have to be divulged?

 

[RayNY]

Allen,

Yes, the carrier can tell providers if the insured is currently paid to date, lapsed, or in the grace period.

But, providers in most states have no way of knowing if this even applies to a given patient. The 90 day grace is only on-exchange, and they have no way to know if a given client is on or off exchange without verifying every one.

This is the reason many doctors turn away "obamacare", and why some states like TX are proposing laws to note exchange/subsidy status on cards.

 

[AllenChicago]

Understood. You're a virtual ACA reference manual, Ray! Thanks for the clarification and explanation.

 

[Ann H]

Thank-you, Ray!

 

[RayNY]

You're welcome guys!

 

[AllenChicago]

Allen,

Yes, the carrier can tell providers if the insured is currently paid to date, lapsed, or in the grace period.

But, providers in most states have no way of knowing if this even applies to a given patient. The 90 day grace is only on-exchange, and they have no way to know if a given client is on or off exchange without verifying every one.

This is the reason many doctors turn away "obamacare", and why some states like TX are proposing laws to note exchange/subsidy status on cards.

The pressures and risks associated with our President's signature "achievement", are causing an increasing number of physicians to close their practices. Here's an Opinion from one local physician who's doing just that..

Editorial: http://www.chicagobusiness.com/arti...are-system-taking-toll-on-my-physical-therapy

 

[AllenChicago]

The pressures and risks associated with our President's signature "achievement", are causing an increasing number of physicians to close their practices. Here's an Opinion from one local physician who's doing just that..

Editorial: http://www.chicagobusiness.com/arti...are-system-taking-toll-on-my-physical-therapy

February 26, 2016

An amazingly sad statistic is that American Physicians have the highest suicide rate among all professions. This study was done when Obamacare was first taking hold...

The 10 Professions With the Highest Suicide Rates - TheRichest

One would presume that the additional pressures and stress brought by ObamaScrew, are making things worse for our physicians.

I wonder if they like Bernie Sanders "single-payer" plan more, or the Repeal and Replace with "something" that Trump is promising???