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Who Picks Up The Tab When Affordable Care Act Customers Can't Pay?

Flickr Photo/Army Medicine
A health premium grace period built into the Affordable Care Act can create a bill limbo for providers and patients.

It’s one thing to get people to buy health insurance, something the state’s health exchange has been focusing on. But what happens when a patient can no longer pay monthly premiums — who would then be responsible for the medical bills? Doctors are worried they’ll be stuck holding the bag, and they’re taking their issue to Olympia this week.
Call it one of the unintended consequences of the Affordable Care Act. The scenario goes like this: Cancer patient buys health plan through the exchange. Patient gets chemotherapy at the doctor’s office. But then the patient falls on hard times and gets behind on paying the monthly premium. In the meantime, the medical bills pile up.

Jennifer Hanscom, executive director of the Washington State Medical Association, said doctors want to make sure patients have access to care, but they also want assurance they’ll get paid for their services. “We need to make sure that we have health care professionals willing to deliver care to these exchange patients,” she said.

Under the Affordable Care Act, patients who buy health plans through the exchange have a 90-day grace period to get caught up on premium payments. The law states that insurance companies are responsible for claims incurred in the first 30 days. Anything after that falls to the health care provider.

The state’s medical association wants to change that. A proposal before the Senate Health Care Committee would require insurers to cover claims during the whole three-month grace period.

Hanscom said that otherwise, financial uncertainties might discourage doctors from participating in plans through the exchange. “By eliminating these questions about the grace period status, we can help ensure that physicians truly will be part of those plans and will see those patients for the long term,” she said.

Hanscom said right now there’s no way for doctors to confirm whether a patient’s coverage is current.

Insurance carriers oppose the proposal. They say it’s not up to the state to change that law, but the federal government.

Year started with KUOW: 1994