Wednesday, December 11, 2013

Anecdotal Evidence Of Docs Reluctance To Sign ACA Provider Contracts

Dr. Bradley B.
I received an e-mail from my brother Brad, one of the top dermatologists in Houston, which contained a link to the Texas Medical Association that gives some answers to questions about the ACA marketplace insurance plans.

My brother titled his e-mail: "Wow, check the answer to question 4--- crazy"
Here is what Brad said in the e-mail:
"Why, given that answer, would ANY doc sign an aca provider contract to see patients on obamacare?  I don't know of a single doc at our medical center that has signed an affordable care act provider contract!"
Here are questions 2, 3, and 4 and the answers [partial] from the TMA.    To view the full answers and all the questions and answers, click here.

Q 2:  How will I know which of my patients are on an exchange plan?
A: At this time, there is no requirement for health plans to identify which of your patients are on an exchange plan. Some companies may choose to identify those plans. ...

Q 3:  What do I do about the 90-day grace period? I’m worried I won’t be paid by the insurance company if the patient has not paid the premium.
The Affordable Care Act gives patients who receive a federal subsidy in health insurance exchange plans three months to pay their premiums. For the first 30 days of patients’ coverage, the insurers are required to pay claims under the federal regulations and accept the government advance tax credit as payment of the premium. However, for the last 60 days of the grace period, there is no such mandate. If the insured person does not pay his or her premiums within the grace period, the law does not require the insurer to cover any services the physician provided during months two and three.
Insurers in the last two months (of the three-month grace period) may pend or pay for services provided to their insured persons (physicians’ patients). The Texas prompt pay law may even require payment for some portion of the last two months of the grace period. If an insurer pays in the last two months, then, if the insured person (patient) does not pay past-due premiums, the insurer may recover from the physician any payments made to the practice. The patient must then pay for all past services out of his or her own funds.

Q 4. Will physicians have to refund payments to an insurer if a patient who bought coverage from that insurer in the Affordable Care Act (ACA) marketplace doesn’t pay his or her premiums?
A. Yes, possibly. Here is what the government said in the March 27, 2012, Federal Register, when adopting the regulation:
We note that QHP [qualified health plan] issuers may still decide to pay claims for services rendered during that time period in accordance with company policy or State laws, but the option to pend claims exists. If the individual settles all outstanding premium payments by the end of the grace period, then the pended claims would be paid as appropriate. If not, the claims for the second and third months could be denied. The grace period under this final rule represents an extended time for enrollees to catch up on premium payments before coverage is terminated. (Emphasis added.) ...
Yes, my brother Brad is just one doctor in Houston, but I bet we can find many doctors across the nation that can relate similar experiences.

President Barack Obama stated emphatically, "you can keep your doctor, period."  I wonder how many doctors he talked to before he made that statement [lie]?


bradley said...

Big mike, a doctor offers health services to patients in need, BUT all under the umbrella of a business ---- rent must be paid , medical assistants do not work for free, malpractice insurance premiums are ridiculous, office and surgical supplies cost money-- if reimbursements are significantly under Medicare rates, which they are under most of the aca plans so far offered, then that business will go under, than NO patients will be served ---plain and simple, Obama consulted the AMA which represents less than 30% of the practicing docs in this country!!

Big Mike said...

Thanks brother for your comments. And thanks for your work which has helped thousands of Texans [as I know you have patients coming in not just from Houston].
You the man!!