How to Avoid Non-Payment When Patients Drop ObamaCare Coverage

Did you know that patients who signs up for the Affordable Care Act (“ACA” or “ObamaCare”) have 90 days to pay for the insurance or cancel it?  A patient can enroll in the health exchange and the insurer must provide coverage for 90 days before being able to drop the enrollee.

Health care providers may be told the patient has insurance and later find out the insurance has been cancelled.  This grace period may leave health care providers holding the bag.

“Those who buy insurance through [the health exchanges] will have 90 days to pay before coverage is canceled, potentially leaving providers on the hook.  A safeguard designed to protect people who buy health insurance through the new federal marketplace has hospitals, doctors and other healthcare providers concerned that they might not be paid for some services under the Affordable Care Act.

People who don’t pay their monthly insurance premiums will have a 90-day grace period before their coverage is dropped. Federal regulations require insurers to pay claims for the first 30 days after payments lapse. After that, they will be able to deny pending claims, leaving [providers] to foot the bill.”

NJ Spotlight, October 9, 2013

Various physician groups have sent letters to Medicare expressing alarm over this grace period.  The health care provider certainly doesn’t want to be in the position of providing care on the basis that the patient had insurance and later find out the patient cancelled the insurance.

Under the regulations, the insurer is supposed to warn the healthcare provider that they are about to stop paying the patient’s claims.  Your billing department will have to have a system to notify the front desk if insurance coverage is about to stop.

The best way to prepare for ObamaCare is to be informed.  Your staff should have a basic understanding of the new law and know where to get answers if they have questions.

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