Providers May Bear Burden for ‘One-Size-Fits-All’ Insurance Exchanges

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Health insurance exchanges, which open across the country in less than a month, may place a hidden burden on healthcare providers because of limitations related to making health insurance universally available.

As Michelle Andrews at Kaiser Health News notes in a recent article (“Complex Personal Issues May Cloud Decisions about Buying Insurance“) many people who sign up for insurance on the exchanges will find selecting the right plan complicated and unclear. ”What’s striking is the complexity of some of the health insurance dilemmas people are trying to sort out,” Andrews writes. “Getting them answers will be no simple task.”

Considering the complexity of the application forms for the exchanges (currently a dozen pages for  individuals with access to health insurance through their job or for families), many people will require assistance filling them out. But as Andrews writes, despite the complexity of the application, they are still not long enough to cover special circumstances of many people with complicated family relationships and employment.

“Consider the self-employed divorced couple whose annual income ranges between $30,000 and $200,000 and who split custody of their children,” Andrews writes as an example. “They want to know whether they’ll qualify for subsidized coverage on the exchanges, but ‘the forms don’t address these things,’ they write.”

The exchanges will have “Navigators,” specially trained staff who will be available to answer questions from those purchasing health insurance. These individuals will be trained, presumably, to help consumers navigate the labyrinthine steps to purchase insurance. ”Figuring out how to work through a multi-layered question to get to the simple answer will take practice,” Andrews writes.

The one-size-fits-all design of the exchanges will place a burden on healthcare providers as well. As we reported back in the spring, when Massachusetts rolled out its insurance exchange in 2006, many providers ramped up their patient financial services departments to get their patients registered. The Healthcare Financial Management Association (HFMA) published an excellent case study of Boston Medical Center, which doubled its PFS staff to help patients get signed up for health insurance.

In anticipation of this, the Centers for Medicare and Medicaid Services (CMS) have identified a role they call a “Certified Application Counselors.” For the federal exchange that will be rolled out in those states that have elected not to create their own, providers and other organizations can be designated “to certify application counselors who perform many of the same functions as Navigators and non-Navigator assistance personnel—including educating consumers and helping them complete an application for coverage,” according to the CMS website.

A few weeks ago CMS unveiled a web site where certified application counselors and others can find resources to assist with getting individuals and families signed up for health insurance via the exchanges. Through September CMS will be holding webcasts to help organizations explain to their clients how to sign up for health insurance. A brief overview of the process will be broadcast today (Thursday, Sept. 5) at 1 p.m. Eastern Daylight Time (https://goto.webcasts.com/starthere.jsp?ei=1020210) and on Wednesday, Sept. 25, at 1 p.m. (September 5, 2013 1:00 – 2:00 pm ET https://goto.webcasts.com/starthere.jsp?ei=1020210).

An advanced explanation with greater detail covering eligibility, enrollment, plan structure, Medicaid expansion, and the streamlined application will be held next week on Wednesday, Sept. 11, beginning at 1 p.m. EDT (https://goto.webcasts.com/starthere.jsp?ei=1020218).

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Posted in Denials Management, Medical Receivables, Patient Experience, Patient Financial Services .

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