This has physicians worried that HIX patients who show up in their offices wanting services will unknowingly believe they are covered when in fact they are not. This is particularly a concern in states that have federally facilitated exchanges because of all the enrollment glitches and remaining back-end problems on the federal enrollment website.
Second, physicians have genuine reason to be concerned about the 90-day grace period that consumers have under PPACA when they don't pay their premiums. Under the healthcare reform law, certain individuals can't be terminated from coverage for failing to pay for 90 days. Health insurance plans pay claims for the first 30 days, but can deny or pend the claims for the remaining 60 days if the enrollees don't pay.
At issue for physicians is knowing when an enrollee has entered into the 90-day grace period.
"Providers are on the hook for services provided and everybody is very anxious about it," says Tom Holloway, executive vice president of the Missouri State Medical Association (MSMA), which, along with the Missouri Hospital Association, sent its second joint letter to the Center for Medicare & Medicaid Services asking the agency to address the 90-day grace period. CMS responded in September that it would publish "guidance" to establish notice parameters.