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March 21, 2014
Premiums? What premiums?! The AMA's revolt against Obamacare
Posted by Laura
Remember when the American Medical Association (AMA) rushed to the Democrats’ side in supporting the “Affordable Care Act” despite concerns raised by many of the member physicians? Well, as predicted, the AMA is having major second thoughts. The implementation of Obamacare is not only compromising physicians’ independence in myriad ways, it is hitting health care providers big and small where it hurts—their pocketbooks.

Medical writer Mark Crane explains the latest hellish development in the Obamacare rule making process:

Physician practices could be put at financial risk because of a little-known rule in the Affordable Care Act (ACA) that provides a 3-month grace period for consumers who do not pay their premiums on time, several national medical organizations have complained.

The rule, published by the Centers for Medicare & Medicaid Services (CMS), grants individuals who purchase subsidized coverage through the state insurance exchanges a 90-day grace period before their coverage is cancelled for nonpayment.

During the first 30 days of the grace period, insurance companies are required to pay for any claims submitted. However, insurers are allowed to "pend" any claims submitted during the second and third months of the grace period and may ultimately deny such claims if the consumer does not make the missed payment, the rule states.

Healthcare providers may not be aware that a patient is behind on premiums until after he or she is through the grace period, when the provider is responsible for the bill. Physicians could be on the hook if those claims are denied.

The American Medical Association, along with most national specialty societies and state medical organizations, recently sent a letter to CMS Administrator Marilyn Tavenner to raise concerns about the grace period's effect on physicians.

03/21/14 9:49 AM
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