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Health Care Reform:

Health Insurance & Affordable Care Act

Obamacare Adds One More Step for Doctors


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.

For a brand new program, that’s to be expected, he adds. And it doesn’t mean the exchange isn’t working. The real test will be what happens in April, when open enrollment ends and everyone who has purchased a plan offered through the health law’s online exchanges plan is clearly covered.

In the meantime, Lawless offers this advice to patients who have bought plans on the exchange: “If you pay your premium prior to [visiting the doctor], print that out and bring it with you because that will certainly save all a lot of grief.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Mon, Feb 24 2014

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