Insurance Exchange Patients Will Pose Payment Risk

A loophole in the Patient Protection and Affordable Care Act will make patients who purchase insurance through exchanges a higher risk from a collections standpoint.

Health insurance exchanges across the nation will open for business Jan. 1, and the blog Medpage Today has reported on a loophole in the ACA that will complicate collections from patients who purchase insurance. Patients who fail to renew their insurance premiums will have a three-month grace period from the expiration of their policy. At the end of that three months insurers will deny any claims made by providers during that period. Providers will then be responsible for collecting directly from the patient.

For the first two months after expiration of the insurance policy insurers will pay claims; the third month insurers will hold claims and if they patient fails to renew their policy, will deny the claims at the end of three months, according to Medpage Today. This differs from traditional health insurance where payors pay claims during the entire three month period, according to Elizabeth McNeil, vice president of the California Medical Association (CMA) in Sacramento.