A 90-day grace period under the Affordable Care Act (ACA) could create a burdensome situation for physicians and patients if insurers don’t notify doctors right away when a patient enters the grace period after missing a premium payment. The AMA and more than 80 other groups sent a letter Wednesday to the Centers for Medicare & Medicaid Services (CMS) calling for stronger notification requirements.
The letter urges CMS to require insurers to notify physicians as soon as a patient who has purchased health insurance through an ACA exchange enters the grace period, recommending that this notification should be provided as part of the insurance eligibility verification process.
“It is essential for physician practices to have accurate, up-to-date information in order to work with patients and plan accordingly for potential financial liabilities associated with non-coverage,” the letter states.
While health insurers must pay claims for the first 30 days a patient is in the grace period, insurers may place a hold on claims for services that took place in months two and three of the grace period. If the patient doesn’t pay the missed premium within the remaining time, the insurer may not pay the claim, leaving it up to doctors to tell their patients that they have to pay for their entire treatment.
“CMS has unfairly shifted the burden and risk of potential loss for patient non-payment of premiums to physicians,” the letter states. “This financial burden will be untenable for many physicians.”
Current notice requirements are inadequate in that they simply require insurers to notify physicians of the possibility for denied claims when the patient is in the second and third months of the grace period, the letter states. The timing and manner of notification is left to the discretion of insurers. The associations urged CMS to issue clearer guidance or supplemental rules that would require insurers to give physicians within the first month a patient is in the grace period.
The AMA is developing tools to help physicians navigate the current complexities of the ACA grace period, which are scheduled to be released later this month.
