Doctors groups are worried that their members won’t get paid because of an unusual 90-day grace period for government-subsidized health plans. Now they’re urging physicians to check patients’ insurance status before every visit.
“This puts the physician and their patients in a very difficult situation,” said Dr. Ardis Dee Hoven, president of the American Medical Association (AMA).
The AMA advised physicians Wednesday about how to minimize their risk.
“If a patient is being treated for a serious illness, that requires ongoing care,” she said. “The physician is having to assume the financial risk for this. That’s the bottom line.”
If an enrollee in a subsidized plan falls behind on their premium payments, the Affordable Care Act requires insurers to cover their medical bills for 30 days.
But for the next 60 days, insurers may “pend,” or hold off paying the claims – and ultimately, deny them if the patient doesn’t catch up on his premiums. That means doctors don’t get paid for their services. If the insurer ends up canceling the policy after 90 days, doctors can bill patients directly but may face difficulty collecting.
“The doctors get left holding the bag on pending claims,” said Robert Laszewski, a former insurance executive and consultant.
The way things work now, insurers generally cancel a policy if a subscriber falls behind more than 30 days. The insurer is usually on the hook for bills incurred before that cancellation.
The AMA and dozens of other physician groups have urged the Obama administration to spell out how and when insurers must notify physicians when their patients fall behind on premiums.
Some experts worry that doctors who know they may not get paid have a strong incentive to withhold treatment. They may also insist on being paid upfront in full, which could be a breach of their contracts with insurers.
“The reason they want that notification is so they can start denying services,” said Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service.
If the insurer happens to notify the physician and tell them, “Hey, your patient is behind on their premiums and we’re going to put a hold up claims payments,” we know that nine times out of ten that doctor isn’t going to provide the services — no matter what their network contract says.
It’s as if the ACA is at war with medicine, and wants to make doctors out to be the bad guy. The only winner here is the insurance companies selling government-sanctioned plans — they get paid, and if not, they don’t pay anything. Meanwhile, patients get taxed if they choose not to participate (that’s losing) and doctors have to care for patients up to 90 days, knowing full well they might never get paid (that’s definitely a losing outcome).
“The doctors aren’t bad guys — they’re business people,” Haile added. “Any economically rational actor would do it.”
And now it looks like treating patients who have fallen behind on their insurance payments will end up being even more costly.
Thank you, red tape.