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Society, WHA seek change
in ACA ‘grace period’

In a letter last week, Wisconsin Medical Society CEO Rick Abrams and Wisconsin Hospital Association President Steve Brenton encouraged the Centers for Medicare & Medicaid Services (CMS) to change the “grace period” provision in the Affordable Care Act (ACA). The provision gives a three-month grace period to beneficiaries in the new Health Insurance Marketplace who haven’t paid their premiums and requires insurers in the Marketplace to pay all claims during the first 30 days of the grace period.

It also allows insurers in the Marketplace (also known as health insurance exchanges) to hold on to and ultimately deny claims during the next 60 days of the grace period if coverage is terminated due to a failure to make premium payments – meaning physicians will need to seek payment from the patient.

Under more traditional employer-sponsored health plans, insurers still are liable for paying physicians even if the beneficiary or employer hasn’t paid their premiums.

“This process unduly burdens physicians, hospitals and other health care providers with a double whammy: First, they provide the care. Then, they bear the burden of having to collect private payment from the patient for care rendered during the final 60 days of the grace period if the patient fails to pay his/her premium, or shoulder the unfair and significant risk for providing uncompensated care,” Abrams and Brenton wrote in this letter to CMS Administrator Marilyn Tavenner.

In the interim, the Society and WHA also are asking CMS to ensure physicians and other providers are able to access a real-time notification process that allows them verification that a beneficiary in the Marketplace has met the premium payment obligation to the insurer.

The Society strongly encourages all physicians and clinics that plan to accept insurance from qualified health plans in the Marketplace to verify the insurer’s grace-period policy early in the contract process.

Back to August 22, 2013 Medigram