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CA Doctors Could Face Potentially Nasty Surprise

A little-noticed provision in the Affordable Care Act allows exchange participants a 90-day grace period to pay their health insurance premiums.  This was designed to help those who are not used to paying health insurance premiums.

During the first month of grace period when the premium has not been paid, the insurance companies must continue to pay claims incurred by the patient.  During the second month if the patient is still delinquent the insurance company can pend any further claims.  After the third month if the insured has not paid the premium, the insurance company can terminate the coverage.

In the event that the premium is not paid during the grace period and the policy terminates backwards 90 days, doctors  and other healthcare providers in California will have to go after the patient to collect payment for all outstanding claims. 

Essentially this means there can be a 60-day period during which a medical provider who accepts exchange-level health plans is not going to be sure if or when he/she may ever get paid for the medical services provided.

Excellent article from Family Practice News about this.



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