Obamacare Leaves Doctors On the Hook for Deadbeats

OK.

Let's get this straight. ...

You buy an insurance policy on the exchange and qualify for a subsidy.

The subsidy amount is paid directly to the insurance company and you pay the difference.

According to the law,,, if you pay at least one month's payment and then decide you "Can't" pay,,, then you are entitled to a 3 month "Grace Period" that would force providers to continue 'coverage' (for the 3 month period) and possibly only get paid from the insurance company for the first month of the "Grace Period" ?

I think I'm understanding this right but it's more confusion and may not be accurate.

But I wonder how much that will end up adding to everybody's rates ?

I'm sure the only people that will use this "Grace Period" are ones who are genuinely in need.

The article states that this has happened in Massachusetts under their State version of RomneyCare.

Tucked inside nearly 11,000 pages of the Affordable Care Act is a little-known provision that doles out three months of free health care to individuals who choose to default on their premiums.

People who receive the federal subsidy to be part of Obamacare will be allowed to incur a three-month “grace period” if they can’t pay their premiums and then simply cancel their policies, stiffing the doctors and hospitals.

Their only repercussion is that they have to wait until the following year’s open enrollment if they want coverage on the exchange.

Can somebody please clarify this...
Obamacare Leaves Doctors On the Hook for Deadbeats


PPACA section;
45 CFR 156.270 - Termination of coverage for qualified individuals

reply to post by xuenchen


Since when did "insurance companies" become synonymous with "doctors?" Is he saying that you will have insurance during the grace period but the insurance company will not pay any claims? Here's the relevant language:

(d) Grace period for recipients of advance payments of the premium tax credit. A QHP issuer must provide a grace period of three consecutive months if an enrollee receiving advance payments of the premium tax credit has previously paid at least one full month's premium during the benefit year. During the grace period, the QHP issuer must:
(1) Pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period;
(2) Notify HHS of such non-payment; and,
(3) Notify providers of the possibility for denied claims when an enrollee is in the second and third months of the grace period.

So the insurance companies HAVE to pay the claims, notify HHS of the delinquency and notify all the providers that claims after the grace period ends may not be paid. This is hardly "Obama leaving doctors on the hook."

reply to post by theantediluvian

.....
So the insurance companies HAVE to pay the claims, notify HHS of the delinquency and notify all the providers that claims after the grace period ends may not be paid. This is hardly "Obama leaving doctors on the hook."

Sounds like the insurance only pays for the first month.

Then gets paid if and when the patient pays the premiums.

If the patient defaults or cancels, the insurance company might not pay for services incurred in the 2nd and 3rd month of the grace period.

(1) Pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period;

xuenchen
reply to post by theantediluvian

 

.....
So the insurance companies HAVE to pay the claims, notify HHS of the delinquency and notify all the providers that claims after the grace period ends may not be paid. This is hardly "Obama leaving doctors on the hook."

Sounds like the insurance only pays for the first month.

Then gets paid if and when the patient pays the premiums.

If the patient defaults or cancels, the insurance company might not pay for services incurred in the 2nd and 3rd month of the grace period.

(1) Pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period;

Yes, I think you're right. I wonder what the obligations of hospitals and physicians are once they've been notified of the premium payment delinquency?

(c) Termination of coverage due to non-payment of premium. A QHP issuer must establish a standard policy for the termination of coverage of enrollees due to non-payment of premium as permitted by the Exchange in §155.430(b)(2)(ii) of this subchapter. This policy for the termination of coverage:

Assuming it hasn't been addressed in another part of the PPACA, this is something that looks like it is in need of refinement.

pretty slick way to cut costs by 67%. anyone who deals with health insurance companies already knows that they will do and say WHATEVER IT TAKES to get you to provide care for a patient and then simply NOT PAY the claim. Standard Operating Procedure. eventually and ideally, from the gov and insurance co perspective, the ACA will allow them to collect inflated premiums and penalties, pay out nothing, split the money and just force (legislate) the care to be performed anyway.

ETA id be in favor of a system in which the fee for the service is electronically transferred from the insurance company's account into mine BEFORE i see the patient. why couldn't/shouldn't that be done? that way i never have to worry about getting the shaft. the only reason to do it the other way is so that they CAN give me the shaft. this "I'd gladly pay you Tuesday for a hamburger today" system sucks.

Who cares about doctors and hospitals? They didn't do squat to stop this law when they had a chance. These people were all in it together. Now they're just trying to suck more government money. Serves them right if they don't get what they thought they would.