opening of the health insurance marketplaces under the Affordable Care Act (ACA)
on Jan. 1 means you must be vigilant in your dealings with the health insurance
companies. Or you could face major problems. For example, do your existing
contracts with insurers mean you're already included in an exchange network? And,
it's possible you'll have to refund payments to an insurer if a patient who
bought coverage in the ACA marketplace doesn't pay his or her premiums.
bottom line is doctors will have to be vigilant about their contracts and about
tracking patients and payments for exchange plans, and it may be difficult at
first," TMA Vice President of Medical Economics Lee Spangler says in a
story to be published in the December issue of Texas Medicine. Because of the urgency of this issue, we're
bringing it to you three weeks early. It's posted on the TMA website.
We also have a PDF
version for you to print if
are some highlights of the story:
in an exchange plan is voluntary, so you must decide whether to opt in or, in
some cases, opt out. Because insurance carriers take different approaches to
forming networks for exchange plans and notifying doctors about those choices,
you must closely evaluate your existing contracts and any new offers you
insurers use their existing network contracts, you may be notified by the
insurer, but that is likely to be an exception rather than the rule. While some
carriers have created new networks, they may apply to only one type of exchange
health plan, thus, Mr. Spangler says, "doctors could be in-network for one
health plan and not another. There's no guarantee all plans [under a single
insurer] will use the same network."
rates under the various exchange plans could differ from those under existing
Medicaid managed care companies now selling commercial health plans in the
Texas marketplace, you also should evaluate your Medicaid contracts to find out
if you agreed to provide services to exchange patients through those contracts
and if the managed care plans use Medicaid payment rates for their new exchange
regulations give patients in health insurance exchange plans three months to
pay their premiums and allow health plans to deny or later recoup payments from
doctors for services provided to patients who end up delinquent.
are the insurance companies participating in the Texas marketplace as of Oct.
from Superior Health Plan
Cross and Blue Shield of Texas
Health and Life Insurance Co.
Health Plan of Texas
Healthcare of Texas
and White Health Plan
Doc: TMA Answers Your Patients' Marketplace Questions
"Hey, Doc," TMA's multimedia patient education campaign
about the Affordable Care Act (ACA) health insurance marketplace, provides your
patients with no-nonsense answers to their top questions about the law. Since
Oct. 1, people who brave the computer glitches can buy insurance from the
marketplace to comply with ACA's "individual mandate," which requires
everyone to be covered next year.
"Hey, Doc" will continue to provide pertinent, objective, and timely content each week on video, on
the Internet, and in the news media.
To keep up with the program or to refer
your patients, go to www.texmed.org/heydoc/. There you will also find resources for your practice, including
handouts for your patients, and the latest information TMA has gathered on the
Action Special Report, Nov. 6, 2013
Last Updated On
April 05, 2016