Saying Grace

As 2014 approaches and an expected 36 million or so people who have not been insured are expected to start purchasing health insurance we certainly have not had a shortage of surprises. One of the latest Obamacare goodies could make it difficult for those who purchase health insurance through HIX (health insurance exchanges) to actually book an appointment with a doctor.

A little-noticed provision of the Affordable Care Act gives exchange participants a 90-day grace period to pay their premiums. This was designed to provide a cushion for people who might not be used to paying health insurance premiums.

Insurers have to pay all claims incurred by the patient in the first month, but in the second month, if the patient is still delinquent, all claims can be held as pending. By the third month, if the patient still has not paid, the insurer can terminate him or her.

The physician then has to collect payment for all outstanding claims from the patient.

Family Practice News

This essentially makes the physician a lender that is expected to float a no-interest loan for up to 90 days before receiving payment.

Or, they may never be paid for services rendered.

How do you like those apples?

Physicians also will need to pay close attention to the contracts they sign with health insurers that are participating in the exchanges.

When you consider that HIX networks will be much more narrow, essentially HMO type plans, this means astute providers might well refuse to sign a HIX contract with a carrier.

When negotiating rates, be aware that many of the patients who gain coverage via the health insurance exchanges will have pent-up demand for health care because they have previously been uninsured or underinsured, Ms. McNeil advised. Their care could be more complex and time consuming, so doctors will want to be sure that reimbursement rates are adequate to cover this care.

Yeah, no kidding.

No health care for you.