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    AMA issues new salvo on ACA’s 90-day premium grace period

    Association unveils resources to soften the financial risk of a controversial provision in the Affordable Care Act

     

    While the American Medical Association (AMA) is fighting to reverse the financial risk to physicians over the controversial 90-day premium grace period in the Affordable Care Act (ACA), it just released a series of resources to help doctors if confronted with policy jumpers.

    Under the rule, patients who fall behind on their monthly premiums will still be able to keep their coverage for 90 days. During the first 30 days, insurers will be responsible for reimbursing claims for services provided to the patient. But during the final 60 days, insurers may deny claims, and physicians will be responsible for collecting payments directly from patients.

    The Obama administration has announced that more than five million people have signed up for insurance on the insurance exchanges. But insurance industry officials told Politico that as of mid-March, between 15% and 20% of people who have signed up have not paid their first monthly premium.

    The AMA recently wrote to Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner arguing that CMS has “unfairly shifted the burden and risk of potential loss for patient non-payment of premiums to physicians.” The letter also expresses the need for timely notification from insurance companies about patients who have entered the grace period.

    The AMA, along with several other physician advocate groups, have repeatedly argued that insurers should be responsible for payments during the full 90-day grace period, rather than physicians.

    “The grace period rule imposes a risk for uncompensated care on physicians so the AMA has created resources to help medical practices navigate the key aspects of the rule to minimize its potential negative impact,” AMA President Ardis Dee Hoven, MD, said in a statement. “Managing risk is typically a role for insurers, but the grace period rule transfers two-thirds of that risk from the insurers to physicians and health care providers. The AMA is helping physicians take proactive steps to minimize these risks.”

    Next: Resources to help physicians collect payments

    9 Comments

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    • PARDIPSINGH
      I believe 90 day grace period is too short and it shall be expanded more. Read more
    • Anonymous
      Grace period is one thing, but how about these mega-deductible plans? Why should these patients be granted a payment plan? They are replacing the insurer in this payment circle and should at least be held to the same 45 day standard by law. But, inevitably, they will blame their inflated premiums paid to qualify for their insurer's discount as the reason their funds are low. Therein lies the rub. The lower the premium, the higher the deductible; and, thereby, our risk. Why should the patient be rewarded for not holding up their end of the bargain? I say put them all in collections after 45 days ...
    • Anonymous
      No one can masked it that healthy diet and regular exercise is the best solution for a better health. And also education on health issues are the intrinsic part of their effective treatment. There are many blogs & articles posted online where we can get a lot of knowledge on health care and their treatment. So to avoid health problems and control the complication. There are many healthcare community sites where we can participate and solve our queries. Knowledge is the best medicine to heal the health. http://www.healthgenie.in/home-care/bp-monitors
    • Dr. Nancy Blake, MD
      Also, if you sign the insurance contract, you have said "I accept these terms". No right to complain anymore. Insurance companies need to be gone from health care. Period.
    • Dr. Nancy Blake, MD
      I came up with a better idea. Do not participate with ANY insurance, get paid the same day, and that way you get paid to do prior auths's, and all the other paperwork. I no longer sit at night doing billing. I am very glad I made the switch!
    • Anonymous
      It seems the AMA never read the ACA Bill either and supported the democrats that voted this in. You get what you voted for; you got what you supported! Suck it up and make changes with your vote in November.
    • Anonymous
      Starting from the era of Clinton healthcare reform, neither the AMA nor the ACP represented it's member physicians. Instead the AMA and ACP were yes men and sycophants, seeking to preserve the standings of their boards. Both then and now, they have abrogated their duties to protect us. I absolutely refuse to accept any patients insured through exchange plans. Period. I'll accept risk based on quality of care. But I refuse to accept risk due to deadbeats. I don't trust Congress, the Obama administration, the AMA, or the ACP.
    • Dr. MK
      Why didn't they do something when the law was still being debated, instead of supporting it whole-heartedly in greedy anticipation of the spoils of government largesse? Now they pretend to care about doctors when they already threw us all under the bus.
    • Anonymous
      Ridiculous. The AMA and the govt, both cartels that have ruined healthcare in this country are trying to blame each other for consequences of a law they both supported but never read, and certainly never understood the ramifications of. Simpler solution is to end the crazy insurance schemes of cover everything and have the individual not responsible for anything. Go back to high deductible means tested plans where patients pay for care they need and then get reimbursed by their insurance. This is the only way to both bring down costs and increase access to care. The ACA just increases the overall costs to the system and to everyone who does not qualify for subsidies. The ACA is just about further destroying what we have now and then trying to pick up the spoils. It's a shame docs don't organize and tell the govt and insurers where to go and just go back to treating patients again. Who do you really trust for your health? 1-insurance company 2- government 3- your doctor.

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