With many Texas medical practices concerned and confused about the 90-day grace period for patients paying premiums on Affordable Care Act exchange health plans, at least one Texas carrier has stepped up to help.
The ACA requires insurance companies to provide 90 days for a patient with subsidized marketplace coverage to pay all unpaid premiums. During the first 30 days of the grace period, insurers must pay for physician services provided to the patient. However, federal rules allow health plans to pend claims for services incurred in the second or third month of that window. Texas law on prompt payment of claims will still apply. If the patient still hasn't paid the premium, the carrier may then recoup any payments made.
"The federal law doesn't make any sense and is wrong," said Texas Medical Association President Stephen L. Brotherton, MD. "TMA has talked to the Centers for Medicaid & Medicare Services about the possible harm this regulation can cause to practices across the state. Officials there acknowledged it's problematic but have not taken steps to fix it. This is not acceptable."
Blue Cross and Blue Shield of Texas (BCBSTX), which is the only insurance company offering ACA exchange plans in all 254 Texas counties, has pledged to help minimize any negative impact on physicians from the grace period.
"We recognize the difficulties presented by the federal law, and rather than holding or denying claims filed during the grace period, BCBSTX will pay physicians," said BCBSTX President Bert Marshall.
Mr. Marshall added that BCBSTX will reach out to encourage patients covered by the company to pay their premiums. "We have a very good track record of working with our members to make sure they get their premiums paid."
If the 90th day passes without the patient paying the premium, however, BCBSTX will recoup any payments made to physicians. It will notify doctors of those recoupments through an explanation-of-benefits notice.
"TMA is calling on other insurers to follow BCBSTX's example," Dr. Brotherton said.
The TMA website offers these additional resources for physicians regarding the ACA exchange plans:
Action, Jan. 17, 2014