Skip to comments.Docs May See Pay Delay Under ACA Exchanges
Posted on 04/16/2013 2:54:08 PM PDT by Nachum
SAN FRANCISCO -- Physicians could face dramatic financial challenges for treating patients who receive health coverage through the Affordable Care Act's (ACA) exchanges starting next year.
Insurance companies will not process claims on patients who haven't paid their premiums in 3 months, leaving doctors on the hook to recoup payment directly from the patients.
The ACA provides a 3-month grace period to individuals who haven't paid their premiums, and the provision could prove problematic for physicians, said Elizabeth McNeil, vice president of federal government relations at the California Medical Association (CMA) in Sacramento.
Plans will hold off on processing claims on customers who haven't paid after 2 months. After 3 months, it will deny all claims "and you will have to seek payment from the patient," McNeil said Friday at the American College of Physicians annual meeting. Patients will be free to sign up for another plan in the exchange and start seeing another provider.
"Why would a doctor sign up [to treat these patients] if they're going to be completely at risk and have to collect from the patient for the care?" she told MedPage Today. "This is a really bad provision in the bill, and we've got to get it fixed."
Under traditional insurance, the plan is still liable for paying doctors even if the patient or employer hasn't paid their premiums, McNeil said, but patients who will be covered under the ACA exchange may not be accustomed to the standard insurance payment set-up.
(Excerpt) Read more at medpagetoday.com ...
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Prepare for a long sabbatical if at all possible. Take a long vacation. Take a leave of absence. Go on Paternity leave. Make yourselves scarce!!
Or scale back sharply, find a cushy government job, stage a work slowdown.
Go on strike!! Do not try to save the public from their folly, anymore than we could save the markets with Stimulus or Bailouts.
Been dealing with this for many years now and if the employer does not pay the premium, the insurance carrier doesn’t pay the doc. End of story.
Some of my docs are seeing an occasional patient show up with coverage through some special fed plan. We always have patient pay for the service and then refund them when/if the insurance company pays. Sometimes hard on the patient but the option is not to be seen or go elsewhere for treatment. My docs are no different than anyone else, they all have bills to be paid, too.
The problem is in this particular case...I would bet that the group bitching about this supported the ACA in the first place....and now that they’ve “read the bill to see what’s in it” - they are shocked and aghast.
“Patients will be free to sign up for another plan in the exchange and start seeing another provider.”
So I wonder how long the patient can ride the merry go round getting care and screwing the providers?
I’m getting every procedure I can before 2014. ACA will not only hurt Doctors but patients as well. No one can afford to pay for real insurance soon and it won’t be available once the Insurance Co.’s are out of business, so Doctors won’t get paid, period. There will be no health care just bureaucracy! Sick Democrat/Socialist bastards!
“We always have patient pay for the service and then refund them when/if the insurance company pays. Sometimes hard on the patient but the option is not to be seen or go elsewhere for treatment. “
In most states if a physician accepts patient payment other than the co-pay and/or the deductible as delineated in the doc’s signed insurance company contract, then that may constitute fraudulent billing. And if repeated often , could end with the doctor facing civil and criminal charges with possible loss of license.
A few million low dollar value lawsuits could well swamp the courts and effectively eliminate their use for quite a long time.
In the United States, the way things work now virtually all claims of this type go through state court systems which are fairly robust and have enough personnel to handle the paperwork. Without those courts in the picture the federal courts won't even have enough parking spaces in a 1 mile radius for all the lawyers!
“Sorry I don’t bill insurance. Please pay in cash or credit card, and submit YOUR claim to YOUR insurance company. Have a nice day.”
I’m taking a job overseas for 2 years...
average annual premium for single 6600 and 12,200 for families. Let’s: see 12,200 divided by 12 is like a thousand dollars a month. How are folks going to afford that?
May very well be true in some states and in some cases. But my doctor clients accept very limited types of insurance and have had no problems thus far with this practice for many years.
What we are already beginning to see are deductibles so large that they will never be met unless a patient has some type of major or catastrophic illness. Enough of these with one insurance carrier and the docs will drop that insurance and just see the patient for a slightly reduced rate on a private pay basis and not have to deal with the insurance side or reporting of treatment information to anyone other than the patient.
The AMA was for Obamacare because they hold the patent on a piece of software that is supposed to digitize medical records. The AMA doesn't represent doctors; physicians only make up 17% of its membership...and I'll bet those docs are administrators and not practicing clinicians.
You might see some gay pediatricians for Obamacare. And Easy Kill Immanuel, Rahm's brother. But your doc? Likely as furious about Obamacare as you are.
Yes, I mean just like the AMA...in this case, the CMA - which is probably the California chapter of the AMA. That was my point.
They will go out of business. They already are! Where its starting to steamroll are physician bankruptcies in Florida.
May I ask where? Or, general area or continent? I know some docs taking a break in New Zealand.
sings going up in many doctors offices NO NEW MEDICARE patients. Where is our health care to come from. Congress has Platinum health care for life, they DID NOT PAY FOR.WE PAID FOR IT. We have RATIONED health care WE paid for. Now they are going after Military and Ret. Military health care which is secondary to Medicare. And I can’t blame the doctor for wanting to work for pennies on the $$!
How about congress going on BC/BS with custom employee/employer payments? Along with a huge pay cut, and term limits.
I have said for a long time that the Congress, Senate, and President must not and should not have health insurance and pensions paid for by the U.S. taxpayer. They should and must live as any other citizen and that alone will shape their policies towards the rest of us.
As for the argument that they need to be compensated at a high level to ensure their fidelity to the nation, we all see how well that has worked out. It hasn’t worked at all.
Late reply but they don’t understand family budgets or “income”. The refer to taxes as revenue. The higher the better. I hate these bastards! They couldn’t budget a hot dog stand! They’d subsidize the suppliers. But with what? Darn Math...