Friday, March 14, 2014

When patients fail to pay their Obamacare premiums health care providers are left holding the bag

    The important thing to understand about Obamacare is that virtually everything is broken. It's a bad, poorly thought out law.
    It had to be, by the very nature of it. The Democrats rammed it through Congress as part of a reconciliation bill. Even the people supporting it had little idea what they were voting for. Nancy Pelosi made headlines when she explained that the bill would have to be passed before people would really understand what was in it.
    The American people are starting to understand and many simply do not like it.
    One little feature of Obamacare is that anyone purchasing subsidized insurance is automatically covered for four months after making a single payment. In other words, there is a 90-day grace period before policies are cancelled.
    I suppose that is something that can be priced into insurance. But what happens next is the shocker.
    During the first 30 days of the 90-day grace period insurance claims will be paid and processed. Any claims during the next 60 days simply will not be paid unless the premiums are paid.
    So doctors and hospitals will be told that a patient is insured, only to find out later that they aren't going to be paid.
    Obamacare already has really low reimbursement rates for doctors. In California, for example, a majority of doctors are simply refusing to see those insured through exchanges. They can't afford to. Refusing to pay doctors and hospitals for services provided is going to make them even more loathe to accept exchange insurance.
    Failure to pay premiums is a big problem with Obamacare. The administration has been trying to hide the numbers, but roughly 20 percent of those who signed up never paid their first premium, and that may be a low number. So instead of 4.2 million being enrolled through the exchanges the number is more like 3.3 million or fewer. If 20 percent of this number eventually defaults on their insurance payments, then roughly 600,000 people will be able to run up doctor and hospital bills under the guise of being insured. Providers will be falsely told that their patients are insured only to find out later that they are being stiffed.
    No doubt many people are going to be upset over the fact that they've paid for insurance and can't find a doctor to accept it. How bad is the problem? Well, it depends on the state. Forbes did an analysis of the availability of specialists and found substantially fewer participate in Obamacare.
    The chart at right shows specialist availability offered by Athen in its PPO plans versus its Obamacare Bronze plans. In some cases the differences are extreme. For example, Anthem PPO customers in Indiana have a choice of 1055 cardiologists to choose from in their plan. Obamacare customers have 74. In other words, only one in about 14 doctors in its regular PPO plans are willing to accept Obamacare patients.
    Anthem was chosen for the comparison because the data was readily available, and its exchange plans tend to be as good or better than most.
    Understand that President Obama has declared policies which don't cover things like maternity care for senior citizens junk. But most Americans would prefer to pay less for their insurance, forego the free birth control they don't need, maternity benefits they don't want, and so forth, and instead have a wide choice of doctors who would be glad to see them.
    Roughly half of American doctors aren't going to accept Obamacare, and that number is likely to rise after they don't get paid.
    Even worse, because of all the money being spent on Obamacare there is no money to pay for the annual Medicare/Medicaid "doc fix," which increases reimburse levels for these programs. Doctors are about to take a 24 percent pay cut and many will respond by refusing to see Medicaid patients.
    So the problem isn't limited to just purchasers of junk Obamacare policies. Soon Granny won't be able to find a doctor, either.
    Thanks Obama!

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