Obamacare Leaves Enrollees Confused

By Christine Kern, contributing writer

Many enrollees confuse “sign up” dates with “coverage effective” dates

As the deadline for enrollment under the Affordable Care Act (ACA) approaches, healthcare is seeing increased confusion among enrollees over the terms of their coverage through health plans sold on the Obamacare healthcare exchanges.

As Modern Healthcare reports, providers are looking to management groups to help address the concerns, as HHS expects another enrollment surge before the March 31 open enrollment deadline.
Of central concern is that enrollees are confusing enrollment in a plan with the start-date of coverage. It is an issue for patients and providers alike.

Medical Group Management Association senior vice president of government affairs Anders Gilberg explained the confusion, saying, “Just because a patient is enrolled doesn't mean they are covered.”  For example, patients who paid their premium and were enrolled on Feb. 20 would not be covered until April 1, he said. That means that a patient who visits a physician’s office and says “I’m enrolled” still needs to have his or her coverage verified by the medical practice.

The need for verification of coverage is resulting in a large number of bureaucratic headaches for healthcare providers, as medical office managers now find themselves interacting with the health plans on frustratingly long phone calls as they try to confirm patients' coverage.

Adam Powell, president of Payer & Provider, a Boston-based healthcare consulting firm, pointed out there has also been confusion over which plans physician practices are signed up for as participating providers. Many insurers have multiple provider networks to offer more competitively priced plans. To keep premiums down, insurers have changed their network designs, often excluding physicians who demand higher rates.

Powell said that determining your physician’s participation in your plan is a bit murky. It's not enough for a medical office to know it has a contract with that insurer. “The physician needs to be aware of which networks they are members of and which they are not, because a health plan may have multiple networks.” He urged providers who have had long-standing contracts with an insurer to double-check whether the contract includes the insurer's new exchange plans.

The MGMA, together with the American Medical Association, has created a checklist for members that help in handling the new health insurance exchanges.  According to the checklist, providers should educate their staff about payment policies, cost-sharing, and other financial information when dealing with patients.

According to Powell, one consequence of the Affordable Care Act has been a move to high-deductible plans which has caused patients to start shopping around for lower prices because they are shouldering more costs out-of-pocket. Physicians need to be prepared for this shift in patient fiscal awareness.

“Patients have more cost exposure now than they had in the past,” he said. “Insured patients that have little savings may have trouble paying their deductible, and may be more interested in comparison shopping.”