Doctor groups fear that their members will not get paid because of the 90-day grace period for government subsidized health plans and urge physicians to check patients’ insurance status before every visit. If an enrollee in a subsidized plan falls behind on their premium payments, insurers are responsible for covering their medical bills for 30 days. However, for the next 60 days, insurers can withhold paying the claims, and even deny them if the patient does not catch up on his/her premiums. Ultimately, this means that doctors don’t get paid for their services. If the insurer ends up canceling the plan after 90 days, doctors can bill patients, but there is no guarantee they will get paid.
The American Medical Association and other physician groups have asked the Obama administration to “spell out” how and when insurers must notify physicians when their patients fall behind on paying their premiums. Some argue that notifications will only lead to physicians denying services to patients, but physician groups disagree, stating that most physicians would not turn away patients, especially those with life-threatening conditions.
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