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The ObamaCare Rollout Debacle Impact on Providers

November 18, 2013 | No Comments
Posted by Frank Ciesla

While the media is focused on the impact on the patients/beneficiaries, the failures of the rollout have significant impact on the providers.

One of the most significant impacts is the cancellation of numerous health insurance policies (so far approximately 800,000 in New Jersey) and a necessity for these individuals to have obtained new insurance policies by December 15th.  A failure to obtain those policies by December 15th, will result in the individuals not being covered by insurance on January 1.  At this point in time, it is not clear whether the President’s “fix’ can or will be implemented and whether it is doable as a practical matter by the states and/or the insurance companies.  This, of course, is a major impact on the beneficiary/patient, but it is also a major impact on the providers.  These individuals, not able to obtain insurance, will now fall into the category of the uninsured, impacting the payments for services rendered by the providers, to these beneficiaries/patients.

For those lucky enough to obtain insurance by January 1, those policies may have a significant deductible.  Again, while this has a substantial impact on the patient/beneficiary, it has a substantial impact on the providers.  Under those policies, the providers will not be paid by the third party payors until the patient has exhausted their deductible.  Providers will, therefore, need to pursue the procedures, which they now have for collecting deductibles, in a much greater number of situations, than in today’s environment, where the deductible is generally a much lower deductible, than could be in effect under the selected insurance policy going forward.

In addition, there is no guarantee that the new policies obtained by the patient/beneficiary will have the same provider network.  This, of course, has two impacts upon providers.  The first impact obviously is whether or not the provider is in the new network, so that they can continue rendering care to the patient, as an in network provider, but in addition, whether or not the providers, to whom the provider refers this patient for other care, are also in the network.  There is no assurance that the patient’s care patterns will not be disrupted, even if they are able to obtain new insurance that complies with the requirements of the Affordable Care Act.

If the proposed “fix” is not implemented on a wide basis, the patient/beneficiaries, whose policies have been cancelled, have two possible choices for obtaining replacement policies.  Under either choice, the policies must meet the requirements of the Affordable Care Act.  The first choice is for the patient to be able to obtain a policy from their current insurance carrier, that is consistent with the Affordable Care Act and not have to go onto the problem-plagued health insurance exchange website.  However, obtaining insurance through this route denies the patient/beneficiary a subsidy.  To the extent the patient/beneficiary qualifies for a subsidy, they can only obtain that subsidy, if they obtain their insurance through the website or in New Jersey the “alternative” federal enrollment process, which ultimately is through the website.

While the next 30 days are critical to the patient/beneficiary, they are also critical to the providers, who will want to know whether or not their current patients will be able to continue to have insurance, as of January 1, that will permit them to continue to access and use their current providers.

One of the additional difficulties in the current federal enrollment environment appears to be the fact that patients/beneficiaries do not have ready access to the network of physicians or other providers, who are in the various insurance product networks, that are now being made available, effective January 1 and, whether or not other physicians, who are presently providing care to these patients/beneficiaries are in that network.

It is very likely that the provider will have to take the pro-active step of informing patients as to what networks they, the provider, are in.

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