Medical Billing Blog

The American Medical Association issued a statement to physicians on Wednesday cautioning doctors on how to navigate a 90-day grace period for government-subsidized health plans. A patient with subsidized insurance who is falling behind in payments is guaranteed coverage for medical bills for 30 days – but insurers can ultimately deny payment during the remaining 60 days. Some doctors and the AMA say insurance companies could delay and then retroactively deny claims made during the 60-day period – a bill then held stuck with physicians.

The Obama administration announced Wednesday that it has rewritten an array of far-reaching rules under the Affordable Care Act, the most significant of which will let people keep bare-bones health insurance policies for three more years. Americans with health insurance policies that don't meet consumer standards set by the president's healthcare law would be allowed to keep their plans into 2017, three years later than originally envisioned, so that people can buy these noncompliant plans through October 2016 and be covered by them until the following September, when Obama’s tenure in the White House will have ended. The healthcare law was designed to phase out health insurance plans in 2014 if they did not include a basic set of benefits and limits on how much consumers can be required to pay out of pocket for their medical care. After the controversy broke, the administration announced in November that state regulators could allow insurers to renew old policies in 2014. Only about half the states have agreed to the extensions. Some, particularly those with liberal, Democratic insurance regulators, have balked at allowing what they consider substandard plans to remain on the market.

Approximately 3 million people have now enrolled in health insurance plans sold through marketplaces created by President Obama’s health law, the administration announced Friday. The milestone indicates nearly a million additional people have signed up since the end of December. It also suggests that the marketplaces are continuing to recover from a disastrous launch on Oct. 1. That still leaves the Obama administration lagging behind its initial projections for overall health law enrollment--but also closer to hitting monthly sign-up expectations it set back in September. The numbers are reassuring for supporters of the Affordable Care Act, who were worried that the pace of sign-ups for private plans would slow in January and February, before picking up again as the March 31 enrollment deadline for 2014 coverage approached. But they are still shy of initial projections from the Centers for Medicare and Medicaid Services, which originally expected 4.4 million people to sign up for a plan by the end of January. Moreover, the administration has not provided data on how many of the people who have signed up for plans through the exchanges have actually made a payment, which is required to ensure coverage. 

Late morning on Thursday, November, 14^th, President Obama proposed a plan to allow insures to extend policies that existed on October 1^st to existing customers through the end of 2014. In the majority of cases, these plans are less expensive policies, but offer none of the new essential benefits that are guaranteed under the Patient Protection and Affordable Care Act. Before any cancellation notice was ever sent out, the writers of the PP-ACA included a ‘grandfathered’ clause in the original law. Even though they did not meet the law’s standards, if they were purchased before March 2010 and neither the policy holder nor the insurer made any substantial changes, it was legal for the policy to be sold. On Thursday, the President expanded the net of policies that fall under this clause.

As members of the Obama administration testify before Congress to the rampant technical problems plaguing healthcare.gov, new criticisms are being thrown at the administration for failing to keep their promise that the Affordable Care Act would not require people to change their health plan if they were happy with their coverage. Reports are circulating on all major news outlets highlighting how individuals are receiving cancelation notices from their insurers, often leaving individuals stunned and upset. No one currently knows how many of the estimated 14 million people who buy their own insurance are getting such notices, but the numbers are substantial. Insurers are reporting discontinuation rates of 20-80% of their individual business. Below is a guide to help you better understand the bigger picture.