Physicians brace for ACA insurance eligibility headaches in January

January 2, 2014

Millions of people might be signing up for healthcare insurance under Obamacare, but verifying their eligibility may pose major administrative challenges for physicians in January. Management experts offer advice.

With more than 1 million newly insured patients entering the healthcare system in the first round of Affordable Care Act enrollments, there will no doubt be confusion among physicians and patients across the country in the first months of implementation. Many patients who signed up for coverage in December may not have insurance identification cards yet, but they still may be calling to make appointments.

National chain pharmacies, including Walgreens and CVS Caremark, have received media praise for offering patients with new or transitional insurance plans a 15 to 30 day supply of prescriptions with no upfront cost.

But what options do physician-owned practices have when scheduling patients who say they have insurance but have yet to receive identification? Experts say that practices should prepare to spend even more time verifying coverage, and they must consider using cash reserves to float payments for the next few months.

“Make sure your practice credit line has money available and take cash or credit cards,” says H. Christopher Zaenger, CHBC, a consultant with Z Management Group in Barrington, Illinois. “Copy all the information on patients cards and for those who do not yet have cards, get their application paperwork and the plans they are joining ‘by specific name and number’, then go to the Qualified Health Plans website and verify the coverage and effective date.”

Depending on whether your patient has a plan run by the state or federal government, the verification process will be different. If your state has a federal-run marketplace, it is best to call customer service for the plan to verify coverage. A database of health plan contact numbers is available online. Find contact information for state run plans on the left-hand of the Healthcare.gov website.

It will also be up to practice staff to continually educate patients about their payment responsibilities. “Remind your patients to keep all of their paperwork and receipts from all of their doctor’s appointments and from the pharmacy as well,” says Reed Tinsley, CPA, healthcare consultant from Houston, Texas. “They may need them for their insurer. Remind them they should carry their card at all times. If they don’t have a card, they can contact their plan to get a card.”