HMS Exclusive: What Happens if a Privately Insured Individual Doesn’t Pay His/Her Premium Under the ACA?

We’ve been hearing a lot about the insurance exchange and the enrollment process.  But, there has been very little discussion regarding insurance premiums and the privately insured, specifically, the consequences of a privately insured individual who is unable to pay his/her premium on time.  Of course, this isn’t an important matter for people insured through their employer since most employers tend to pay premiums on time (or it’s automatically deducted from employees’ paychecks).   So, what happens when an individual buys insurance through the exchange but then does not pay the premium?

According to experts, insurance companies have “contract language” with hospitals and physicians which allows for a 90 day grace period for a patient who has an exchange plan and then suddenly stops paying his or her premium.  For the first 30 days, the insurer is required to continue to pay claims but in the last 60 days, payment can be withheld.  What does that mean? If a patient fails to pay the premium, they’ll lose coverage at the end of 90 days and physicians will not get paid!

This will significantly impact doctors and hospitals so it is extremely crucial that providers have a plan in place to prevent nonpayment.

HMS recommends your practice does the following to help ensure you get paid for your services:

  • Accept major credit cards
  • Collect all applicable copays and applicable deductibles at the time of service
  • Have strict financial policies in place that clearly outline practice expectations with regards to patient responsibilities. These should be signed by patients acknowledging that they understand the policy and all obligations related to it
  • Payment plan options
  • A collection agency relationship
  • Financial hardship policies

HMS emphasizes that you communicate with your patients the importance of them understanding their policy/contract so that they can be prepared to meet their responsibilities (i.e. co-pays, deductibles, premium dude dates, and the terms of which they can be terminated).

If you have questions and/or concerns, please contact HMS at (203) 294-6659.

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2 thoughts on “HMS Exclusive: What Happens if a Privately Insured Individual Doesn’t Pay His/Her Premium Under the ACA?

  1. Pingback: Monday Morning Recap | hmsabc

  2. Pingback: HMS Blog: 2013 Year in Review | hmsabc

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