If You Enrolled in Health Insurance Through the Exchange, Will You Really Have Coverage on January 1?

December 16, 2013 — Leave a comment
Cross Your Fingers

You may need to do more than cross your fingers to be sure your health insurance starts on January 1. We recommend checking with your carrier if you have not yet received proof of coverage.

This is a question on the minds of many.  With the recent tales of “834 errors*” will insurance carriers really have an accurate record of who is covered under plans sold on the exchange?

* 834 is the data transmission form sent from healthcare.gov to the carriers containing a policyholder’s information.  The 834’s have been plagued with missing, garbled, or duplicate data, casting doubt on whether carriers will receive correct and complete information.

What will happen when someone expecting to be covered on January 1 goes to the doctor, pharmacy, clinic, hospital, etc. after that date only to learn the insurance company has no record of his or her policy?

Who will pick up the pieces?  Should it be the insurance company?  The doctor, pharmacy, etc.?  The person?  The government?

What will happen?

Impact on Insurance Carriers

If you have been following things closely like we have over the past several months, you may have noticed that the insurance carriers have been asked to make last minute accommodations for some of the hiccups experienced with the roll out of the Affordable Care Act (ACA).

For example, when President Obama announced that people could keep their canceled policies after all, carriers were sent scrambling to figure out how and if they could make that happen.

Likewise, extending the January 1 enrollment date from December 15 to December 23 is helpful for the American public, but leaves the carriers somewhat short on time.  Will 9 days really be enough time to get all applications processed?

Can the insurance carriers be asked to pick up the pieces for not receiving the correct data?

Impact on Medical Providers — Doctors, Pharmacies, Hospitals

Let’s think about the providers.  Their goal is to provide medical care.

But the fact is they are also running businesses that must earn income in order to survive.  Can we expect them to provide care to an uninsured individual without being paid?  Even though the patient believed he or she was covered?

Will it only be a matter of time before doctors refuse to accept exchange insurance plans?

What Can Be Done?

These are some tough questions.  And we certainly do not have the answers.

But we can unequivocally dispense this advice:

If you have purchased new health insurance for 2014 and you have no policy documentation or proof of coverage, contact your carrier to verify that you are covered.  Do it now!

We are also watching closely to see how insurance companies react to last week’s announcement by the Department of Health and Human Services (HHS) regarding enrollments in January 1 coverage.

We continue to monitor things and be available to assist our clients.  Do not hesitate to contact us if we can be of service.

Please be patient as we manage a high volume of calls and emails.

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