Health insurance confusion delays operations in hospitals, doctor offices

Jul 21, 2014 | Healthcare Accounts Receivable

Although the Affordable Care Act has only been in effect since last month, the government's health insurance marketplace has been around since October — causing eadaches for Americans and medical practices.

Some patients may not understand their health insurance policy while others are still waiting for proof of coverage, as we discussed in a previous story. Nowadays, the health insurance-related headaches are beginning to shift toward accounts receivable services.

For Sheila Lawless, the office manager of an independent rheumatology office, she takes the initiative to confirm that the visiting patient is in fact enrolled in Texas' health exchanges network — doing this in advance reduces the likelihood that the practice will be in limbo with the health insurance company later on, Kaiser Health News reported.

"You call in and you hit option prompts and you get to listen to no less than an hour of Blue Cross Blue Shield intro music. I could sing you the tune, that's how often I've had to listen to it," Lawless told the source.

Typically, health insurance coverage verification can be viewed online, but those who are a part of the exchange plan will provide this information over the phone. The intent of doing this is to ensure that the patient's premium is paid, that they are not taking advantage of the premium "grace period."

Whenever an individual enrolls into a plan, insurance providers will pay claims for the first 30 days, but if the premium remains unpaid for the next 60 the provider can pend claims and wait or cancel the plan altogether by the 90-day time period.

Lawless' situation is more common than we think. ACA consists of multiple changes, one that may make or break a medical facility's finances. If the percentage of uncompensated care reaches a point where it is not sustainable for staff members, this could put the hospital or doctor's office at risk.

Practices can reduce the likelihood of this worst-case scenario, where a practice sees consistent net losses by outsourcing a percentage outstanding medical statements to accounts receivable management services.