Grace Period Option Can Be Burden on Small Practices

A provision in the Affordable Care Act offers patients who qualify for an advanced tax subsidy when purchasing a product through the exchange a grace period in which they may neglect to pay their premiums for up to 90 days. During the first 30 days of the grace period, insurers have to pay any claims incurred by the patient. But for the next 60 days, nothing is guaranteed. If the patient visits the doctor, the insurer can “pend” the claim – wait to pay the provider until the patient pays his premium. At the end of the 90-day grace period, if the patient has not paid the premium, the insurer can cancel the coverage and refuse to pay the pended claims, or recoup the payments it’s already made. That puts the provider's office at risk.

Practices are encourages to check first with the insurer to make sure everything is in order before proceeding with the visit. If the premium has not been paid, the provider can give the patient the option of rescheduling the appointment or paying in cash and then applying to his insurer for the payment. But this extra step for verification takes time. Insurance companies are scrambling to staff up in order to answer phone calls, as well as offer portals to verify eligibility for these patients. Read more here.   

Please find the latest updates from the Health Benefit Exchange below.

Patty Fontneau blogs about metal tier labels for health plans, which will be discussed at next week’s Outreach and Communications Advisory Group meeting (more info below).

Answers to vendor questions regarding the Provider Directory Services RFI are available here.

SHOP Exchange Manager Jim Sugden blogs about how the Exchange will assist small businesses on the Colorado Health Foundation’s blog Health Relay.

The next Board meeting is scheduled for November 12, 8:30 am. More information is available here.

The Exchange is seeking applicants for several positions; job announcements are posted on our website:

      - The SHOP Exchange Coordinator will provide research and administrative support for implementation and operation of the SHOP.

     - The Documents & Meetings Coordinator will perform administrative functions to support staff, Board and Advisory Group meetings.

      - Outreach Coordinator(s) will engage a variety of communities across Colorado to ensure there is accurate knowledge about the Exchange and effective communication with our partner organizations.

Please see the latest updates from the Colorado Health Benefit Exchange Below.

§  Executive Director Patty Fontneau blogs about defined contributions and assisting small businesses.

§  The SHOP Advisory Group will meet Thursday, Oct. 25, 10 am. More information is available here.

§  The Exchange is seeking applicants for the position of Documents and Meetings Coordinator. More information is available here.

§  The Exchange is seeking applicants for the position(s) of Outreach Coordinator. More information is available here.

§  The COHBE Board will meet on Nov. 12, 8:30 am. More information is available here.