I Don’t Understand This
Traditionally, insurers are liable for processing a claim regardless of whether a consumer has paid his or her premiums. However, the ACA allows insurance plans offered through the exchanges to delay paying the claims of consumers who have failed to pay their premiums for two months and to deny all claims for beneficiaries who have not paid for three months. As a result, physicians who want reimbursement from such consumers will have to recoup their expenses directly from the patient…the claims of beneficiaries who have not paid their premiums might create a “dramatic financial challeng[e]” for physicians and potentially exacerbate a physician shortage, MedPage Today reports.
If every vendor in the world (from gas stations to taxicab drivers) can verify a credit card in a matter of seconds, why can’t doctors verify whether an insurance card is valid?
My first guess would be that policies provide for a premium payment grace period (2 months?) and only lapse after that grace period expires (3 months?).
What response should an insurer give a provider re: status of that patient’s claim? “Well, he’s a bit late on payment, but you can put it through and maybe he’ll have caught up by the time we process it. But, if not, then we’ll be denying it. Stand by.”
I dunno, maybe that would suffice?
I don’t understand it either.
I don’t think that credit cards and health insurance are a reasonable analogy. Card issuers don’t have to issue cards to anyone who asks and they have tight controls over the financial liability they will accept. They can also unilaterally modify card usage, including canceling it. They can share a limited data set on individuals over a vast network that took decades to develop.
In contrast, health insurers have to give unlimited coverage to anyone who asks. They can’t modify policies, they don’t have a data sharing network (no one agrees on the data that should be shared) and any sharing takes place under HIPAA strictures.
A very large chunk of the health insurance market is government coverage. Government doesn’t exactly have a lot of experience monitoring enrollment, and, unlike credit card companies, doesn’t have a history of wanting to bear any risk.
Hence the new practice of shoving it off onto providers.
Looks like it might be necessary, if I were to accept one of these products, to do one of two things (or both):
1) Require proof that last month’s premium was paid, otherwise full payment is required at time of service, to be refunded if insurer does pay
2) Credit card on file (just like when you check into a hotel) to be charged if insurer does not pay in timely fashion.
Docs have been criticized for being poor at business, looks like they are forcing us to be better at it…
I think Dr. Mike has the answer.
If the claim is sizable, shouldn’t it be sufficient to deduct the overdue premium from the claim before it is paid? That would balance the books between the patient and the insurer; the provider could always bill the patient for the missing amount.
Yes bart, stick it to the rich doctor. The doc “could always bill the patient for the missing amount” and then they would never get paid. The patient will simply switch insurers on the exchange and go to a different doctor. Happens all the time now with co-pays and deductibles – if you don’t get these up front and the patient can’t/won’t pay, they just change docs and the old doc never sees a dime. Now some of the insurers will have the same thing happen to them – patient just switches plans on the exchange (allowed in ACA I’m told) and the premium never gets paid. Um, except it does – in the form of higher premiums for everyone.
Starting back around 2000 or so a few of the largest insurers (I was employed with one at the time) were working with banks on the idea of issuing insured members a medical credit card. Physician could collect their fees in full thru the medical credit card; the insurance plan would reimburse the bank based on the actual policy benefits due each person; and the insured would then owe the bank the difference between the full fees and the insurance payment.
I’ve retired and lost track of whatever may have become of this idea.
Later, when Health Savings Account plans emerged, HSA participants were issued a bank debit card that directly charged their HSA account. The HSA works extremely well for me and I still have an HSA balance is in retirement although I no longer have the right to contribute to it. Of course, an HSA can only work for people who actually, you know, have a high-deductible plan and contribute toward an HSA; not everyone does.
ACA missed an opportunity to promote the use of HSA’s not only in the general population, but among seniors as well.
Dr. Mike, my point was that the bulk of a large claim could still be paid on the assumption that if the claim is larger than the premium, the patient most likely wishes to continue the contract and has no reason to cancel.
They’re already sticking it to the doctor; at least this would limit the damage where large amounts are in question.
To Dr. Goodman’s point “If every vendor in the world (from gas stations to taxicab drivers) can verify a credit card in a matter of seconds, why can’t doctors verify whether an insurance card is valid?”, I have to agree with Linda.
I see a Food Stamp card to be more analogous to health insurance than credit cards: food stamps can only be spent on certain services.