Doctors and Exchange Health Insurance

New information has been released about health insurance exchange policies and premium payments. Under the new law, if you buy a policy from the health insurance exchange, you have a 90 day grace period to pay premiums. This is going to have a huge impact on how doctors treat exchange policyholders.

Doctor may be reluctant to treat exchange policy holders. If a doctor treats you while your policy is in the grace period, and then that policy lapses, the doctor may be force to try to collect from the patient. This will create major problems for the medical practice.

Let’s say the patient goes to have an outpatient surgery. The medical practice would file a predetermination of benefits. The insurance company comes back and states the policy is active. They perform the surgery and file the claim. Then let’s say that policy was at the end of the grace period and the insured loses the policy because of lack of payment. The insurance company is not going to pay that claim because the procedure happen during the grace period and the insured did not pay the back premium.  Now the medical provider is stuck trying to collect a $30,000 fee. The probability of them collecting this is very low.

This new information could have a big impact on how doctors treat patients that have an exchange policy.



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