NATIONAL HARBOR, Md. -- The American Medical Association wants health plans to notify doctors when patients haven't paid their premiums, a situation that could leave physicians on the hook for services left unpaid.
Under the Affordable Care Act, consumers are given 90 days during which they can go without paying their premiums and still be covered. However, health insurers don't have to process claims filed during that 90-day period, and won't do so at all if the customer winds up never paying. That leaves providers vulnerable for unpaid services they have already provided.
On Tuesday, the AMA's House of Delegates adopted a new policy at its interim meeting that suggested health plans should be required to notify physicians when their patients have entered that 90-day "grace period."
AMA policy already states that health plans provide physicians with accurate and real-time verification of patient eligibility for ACA subsidies, co-payments, deductible information, and claims processing.
But here at their interim meeting -- which is occurring on the eve of the ACA's effective date -- AMA delegates adopted a resolution that states health plans' failure to notify physicians about when patients enter the grace period would result in a binding eligibility determination on the insurer, meaning the insurer would be responsible for claims made during the grace period.
"Your reference committee believes that this notification would allow physicians the opportunity to inform the patient of his/her status and provide education to the patient on the importance of paying premiums," the AMA's reference committee on medical services, medical practices, and insurance report stated.
The delegates rejected an amendment offered by the Alabama delegation that would have the AMA seek a change in the ACA to force this physician notification.
The reference committee felt that was too strong and that state legislation could potentially address this. New Mexico, for example, has negotiated for re-insurance for those patients whose coverage lapses.
The Texas delegation proposed an AMA white paper -- which would be presented to members by Dec. 15 -- on how physicians can handle interruptions in care because of the grace period.
For example, what happens when the interruption occurs in the middle of a chemotherapy regime? "There's a lot of uncertainty over how you handle those situations," Asa Lockhart, MD, from Tyler, Texas, told ѻý.
The motion was deferred, but Lockhart, who proposed the report, said he still expects swift action from the AMA about this.
AMA delegates also adopted a separate resolution to address health insurance companies sending cancellation notices to customers whose plans aren't compliant with the ACA's new coverage demands.
The resolution urges that the "AMA supports urgent efforts to maintain coverage while facilitating a smooth transition to alternative coverage solutions which offer 'meaningful coverage' " as defined by past AMA policy.
"It was certainly never our intent that patients lose their insurance as a result of our support of the Affordable Care Act," Richard Schott, MD, of Pennsylvania, who offered the resolution, said before the full House of Delegates.
Opponents said the term "meaningful coverage" is ambiguous.
President Obama last week called for an administrative fix that would allow Americans who received insurance cancellation notices to have their policies reinstated for 2014.