The good news is that Affordable Care Act (ACA) has expanded health insurance to millions of Americans. The bad news is that medical practices are struggling with newly-insured patients, many of whom have very low insurance literacy. The practices report that even basic concepts like what’s in and out-of-network are tripping up these patients.
Our clients say they are seeing an increase in patients who are getting appointments thinking they have insurance coverage for their practice only to find out that the practice is out-of-network for the patient, or the care the patient needs isn’t covered.
Of course, these situations rarely end well. Often the patients have to cover the full, or majority, of the cost for their care. Our clinics are typically forced to accept less than their full fee in exchange for the patient’s pledge to pay for the services delivered.
While clinics are starting to post signs cautioning patients who signed up for a new ACA insurance plan to carefully check their policy, an even better strategy is to question the patient when the appointment is made regarding their coverage. Expect to do the research on the patient’s coverage yourself, as getting the patient’s insurance company name and their policy number is a victory in these encounters.
Here’s a good article on the confusion patients in California are feeling when they attempt to utilize their new ACA coverage.
Do you have an Affordable Care Act story to tell? We’d love to hear it. Send it to Michael Kuehn at firstname.lastname@example.org.