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Health Insurance & Affordable Care Act

Obamacare Adds One More Step for Doctors

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“You call in and you hit option prompts and you get to listen to no less than an hour of Blue Cross Blue Shield intro music. I could sing you the tune, that’s how often I’ve had to listen to it,” she says. “My staff said yesterday, it’s a sad shame within their prompts you can’t pick your music as well. If you’re going to have to wait that long, at least let us listen to what we want to listen to!” 

Blue Cross Blue Shield in Texas is the only insurer offering exchange plans in Wichita Falls. Dr. Dan McCoy, the company’s chief medical officer, says part of the problem was the health law’s compressed timeline. 

“Clearly at the end of December there were a significant number of members that enrolled and it’s taken some time to work through that volume in membership,” explains McCoy. “And we know this is a new day in the transformation of American health care. So it’s going to take a little bit of time to work through that.” 

Health Care Service Corp., which owns Blue Cross Blue Shield of Texas, has tried to address the situation by adding another 600 employees at its call center to handle the influx of calls and by extending business hours. McCoy has also been working directly with the Texas Medical Association to work out the kinks. 

Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association in Washington, D.C., a trade group for practice administrators, says the real problem is that signing up for coverage on the exchange isn’t as simple as the White House has made it sound. 

“What we’ve found is that messaging out of the [Obama] administration right now that’s aimed at the public, it tends to oversimplify the complexity of what it takes to get covered on the exchanges,” says Gilberg. “Just because you enrolled in coverage doesn’t mean your coverage is effective.” 

Even if patients pay their premium right away, it could be up to six weeks before their coverage actually starts. To have insurance start at the beginning of a month, the coverage generally must be purchased by the middle of the previous month. A plan purchased on Feb. 14 would be effective March 1. But a plan purchased on Feb. 16, for example, would not become effective until April 1. Go to the doctor before then, and your insurer doesn’t pay. 

“It’s not a surprise that given the subtle nuances and differences of what these exchange products are, that you’re in a gray area right now where there’s a little confusion on the patient side and the practice side. And I think that’s what we’re seeing a lot of right now,” says Gilberg. 

Mon, Feb 24 2014

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