General Category > General Questions

Office fiancial policy changes for upcoming changes with ACA

<< < (2/4) > >>

PMRNC:
I did give the verbiage.. but it's on Pg 292 if you have the full act in front of you.. (pages vary when you have them printed, mine is printed so it's my page 292, Line #9.. repeat what I posted: This provision of the rule applies to all people in all states who obtain subsidized coverage through the state exchanges. It's estimated that 80% of newly insureds will fall into that category. Under the current rule as it is now, Insurers ofering plans on the exchanges MUST provide a three month grace period to individuals who have enrolled and who have stopped paying their premiums. IN the first 30 days the insurer must continue to pay incurred claims. For subscribers who FAIL to pay premiums within the 90 day grace period and who's coverage is terminated, payers are NOT required to pay for claims incurred during the last 60 days of the 90 day grace period.   


--- Quote ---I assume you will look at the premium statement for proof that the previous month's payment was received by the insurance carrier.  Suppose the patient hasn't yet received the premium statement?  And, even if they have a current premium statement, suppose they made the premium payment with a bad check that wasn't caught before the current premium statement was sent out?
--- End quote ---

I think your splitting hairs. Again, I'm discussing these processes with my attorney and the attorneys of the providers I work with as this is above and beyond my scope. BUT it is going to effect us.. and if you charge on a %.. good luck to you as this will be another reason to get as far away from % billing as you can.
Like I said I don't have details pending but I've consulted with legal counsel on our options here as I do believe we have a legal right to request proof of payment. I would imagine if a patient writes a bad check they have to deal with several legalities of doing so and one would be giving us a false statement. But I'm not going to assume anything. I'm going to wait and go through each contract with my clients par agreements and see where we have legal options. I will say this.. since they will only pay the first 30 days of benefits.. I can't see why legally we cannot require up front payment on the other 60 days from this provision.

shanbull:
Thanks for all the info! We do have a state exchange so this definitely affects us. Medical assistance patients and patients with a tier above Medicaid (it's a state-run program) are now required to get their insurance through the exchange, so I believe this involves all of them as well. I let my boss know about it and we're worried that we can't ask for a contract amendment because we're an independent clinic, so taking our business elsewhere isn't as great a threat as it would be if we were part of a bigger system. Please keep us updated on how things go. I would also be interested to see how other independent clinics address this. Our patients are often non-English speaking, elderly (without Medicare eligibility) and/or very poor so asking for proof of premium payment is a little more difficult for us than for some, and we prefer not to create any barriers to care for these people because they are already vulnerable and know very little about how insurance works. Most of the time, lapses in coverage are totally unintentional on their part. It's hard enough to get things sorted out with medical assistance gaps already and they only have a 30 day window.


--- Quote ---Q4:  Will there be any way for the doctor's office to identify these subsidized insurance accounts that are subject to the 90-day grace period?  That is, will there be any way for a doctor to determine what his exposure is to the amount of money he might have clawed back?
--- End quote ---

The answer to the first part of this question is no. There is no difference in the way the insurance ID cards or benefits summaries will look. They policies are still issued by the private insurance companies, so they will have the same uniform appearance as all of the other policies these insurers administer. Some insurance companies do offer specific plans that are only available on the state exchanges, but the only way to identify them is to know the actual plan names. Since the minimum requirements of the ACA apply to all non-grandathered and non-indemnity plans, the coverage details will not be a clue either. This is by design.

Merry:
Sitting here thinking about this..and Linda and I have had extensive conversations about this over the weeks. I think her bringing this up is so important. We are, though just a few people. I cannot imagine what chaos this will cause in the offices that have no clue. These are the very offices who do not have people like us..who make sure that their NPP's were updated in time for the September 23rd deadline, who changed their business associate contracts and who continue to keep the doctors updated.

And I see this also as an opportunity for scams. Person pays one month premium..gets the care that they need..be it a big procedure even involving surgery etc and then does not continue paying.
Do not see this please as a political statement. Far from it. Just that people who put this together were not thinking of the ramifications to the providers.

PMRNC:

--- Quote ---The answer to the first part of this question is no. There is no difference in the way the insurance ID cards or benefits summaries will look. They policies are still issued by the private insurance companies, so they will have the same uniform appearance as all of the other policies these insurers administer. Some insurance companies do offer specific plans that are only available on the state exchanges, but the only way to identify them is to know the actual plan names. Since the minimum requirements of the ACA apply to all non-grandathered and non-indemnity plans, the coverage details will not be a clue either. This is by design.
--- End quote ---

ALL of the individual subsidized plans on the exchanges WILL be identified with the metal plan as well as the individual or family identifiers. ALL of them with those criteria will fall into the 90 days grace period for which the first 30 days are paid leaving the provider at risk. ONE of my clients attorney's has already gotten back to us and he will be requiring all plans on the state exchanges to bring in proof of premium payments. We are waiting however to modify office policies with reviews to any amended contract plans. I have one provider who has already said he'll get out of any plan that doesn't allow him to minimize his risk with this grace period. He's already given me instruction to review and let him know and we will go forward getting out of those plans.

shanbull:

--- Quote from: PMRNC on December 03, 2013, 04:25:52 PM ---
--- Quote ---The answer to the first part of this question is no. There is no difference in the way the insurance ID cards or benefits summaries will look. They policies are still issued by the private insurance companies, so they will have the same uniform appearance as all of the other policies these insurers administer. Some insurance companies do offer specific plans that are only available on the state exchanges, but the only way to identify them is to know the actual plan names. Since the minimum requirements of the ACA apply to all non-grandathered and non-indemnity plans, the coverage details will not be a clue either. This is by design.
--- End quote ---

ALL of the individual subsidized plans on the exchanges WILL be identified with the metal plan as well as the individual or family identifiers.

--- End quote ---

Oh good, this is totally different from what I was hearing from the people who do verification here. I did just sign up on the state exchange today for my own policy (yep, I'm one of the people who had a junk insurance plan, go figure - at least I knew it was junk) so I can let you all know how my card and verification look compared to people with non-exchange plans for this insurer.

One thing I did notice when signing up, there was no mention of this grace period on the consumer end. It just said "payment is due by the 15th for coverage starting on the 1st of the next month." So fortunately, unless patients are experts on the ACA, they will probably have no idea what they can get away with. Still, the problem should not exist in the first place. I don't think it's political to point out major problems with the law going into effect. Heck, I have always supported the law (well, actually, I supported a single payer model) - that doesn't mean it's perfect or without serious issues that need to be ironed out. I'm just hoping something major isn't discovered in the eleventh hour that is even more problematic than this. We don't have the money to get billing held up for months on end indefinitely.

Navigation

[0] Message Index

[#] Next page

[*] Previous page