Obamacare: One secret that will save hours at the doctor
Healthcare reform presents challenges, but we help you avoid them
With any new system, especially one as expansive and game-changing as Obamacare, difficulties undoubtedly arise. In October, we witnessed the botched rollout of Healthcare.gov and cancellation letters enraged citizens who were promised they could keep their health plan. In November, Obama announced that millions of Americans who received a cancellation letter from their insurance company could keep their health plan, that is if their insurance company decided to reverse the cancellations. In January, when coverage kicked in, there was quite an uproar from individuals who discovered that their preferred providers were no longer in-network.
Now, our mission is not to remind you of past difficulties, but rather to help you plan for and avoid future healthcare difficulties. Today, let’s talk about your first visit to the doctor with your new health plan.
How things used to work at the doctor
Prior to healthcare reform, doctor’s offices have been able to make sure patients are insured quickly, by using an online verification system. The patient comes in, shows their insurance card, and the administrative assistant can plug in the information and instantly receive verification that the patient does in fact have insurance.
This verification process is critically important to ensure that doctor’s offices (and hospitals, etc.) will be paid for their services. Otherwise, medical providers might be left high and dry without payment for their services.
But now, everything is more complicated.
How things work at the doctor under Obamcare
Now, exchange patients are starting to use their healthcare and some doctor’s offices are experiencing a major problem: verification.
Office managers at doctor’s offices and hospitals have to call on behalf of each patient with new insurance to ensure they have paid their premiums. Because if the patient hasn’t paid their premiums, then the insurance company can refuse to pay the claim.
As these things never are, the process is far from efficient.
As Shirley Lawless, an office manager at a doctor’s office in
Texas, notes, “We’ve been on hold for an hour, an hour and 20, an hour and 45, been disconnected, have to call back again and repeat the process.”
There’s a provision in the ACA that gives exchange patients a grace period of up to 90 days to pay their premiums. Remember how I signed up on Healthcare.gov and BlueCross sent me insurance cards and a very official looking packet even before I’d paid my premiums? This has caused doctors and individuals a great deal of problems.
Here’s how the 90-day grace period works, according to Kaiser Health:
“During the first 30 days, insurers have to pay any claims incurred by the patient. But for the next 60 days, nothing is guaranteed. If the patient visits the doctor, the insurer can “pend” the claim – that is, wait to pay the doctor until the patient pays his premium. At the end of the 90-day grace period, if the patient has not paid the premium, the insurer can cancel the coverage and refuse to pay the pended claims, or recoup the payments it’s already made. And that puts the doctor’s office at risk.”
Doctor's office administrators already have a lot on their plates--just keeping the office running smoothly--and not many can spare countless hours on hold attempting to verify their patient’s insurance.
So what can you do? The one secret that will save you and your doctor’s office time is to bring your verification of payment to your next doctor’s appointment.
If you paid online, simply print the receipt and bring it to your next appointment. If you paid over the phone, ask your insurance company to email you a receipt that shows proof of payment.
This one step will make everyone’s life a little easier. And healthcare can be complicated enough without having to worry about how long it will take for your doctor to verify your insurance.
Have you been to the doctor this year? Was the process different than it was last year? Share your experience below!
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