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"Grace Period" Rule Could Steer Providers From Exchanges

04/19/13

  11:34:01 am, by MedBen5   , 212 words,  
Categories: News, Health Plan Management

"Grace Period" Rule Could Steer Providers From Exchanges

A provision of the Affordable Care Act has gotten relatively little attention, but has the potential to create some enormous headaches for health care providers.

Family Practice News reports that the “grace period” provision allows 90 days for health insurance exchange participants to pay their premiums. In the first 30 days, insurers have to pay all claims incurred by the patient. But after 60 days of deliquent premium payment, all claims can be held as pending.

At the 90-day mark, the insurer can terminate the patient – leaving the provider responsible for collecting any outstanding claims.

“This is going to put [physicians] at a lot of risk,” said Elizabeth McNeil, vice president of the center for federal government relations at the California Medical Association. “You’re going to have to be very vigilant with the exchange patients in watching what’s going on.”

McNeil later added in an interview, “Why would a doctor sign up if they are going to be completely at risk and have to collect from the patient for the care?”

As word of this provision spreads, it will be interesting to see if it dissuades providers from signing exchange network contracts – especially considering, as McNeil noted, that many of the new exchange patients will have a pent-up demand for care.

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