It is the beginning of the new year, which means patients may be walking into your office with new health insurance.
Some may have gotten new employer-based insurance as many companies hold open enrollment in the fall and the plans become effective on Jan. 1. But this year will also feature a number of patients who have purchased insurance through a state or federal health insurance exchange, made possible under the Affordable Care Act. In any case, you should verify your patients' insurance status when they show up in your office to avoid potential problems getting paid after they leave.
The insurance exchanges are expected to provide new coverage to more than a million people. In many cases, this will be the first insurance these patients have had in years. Many will also have signed up for their plan within the past few days and either may not have received their card yet or may be unaware they need to carry their insurance information.
How do you verify their coverage?
If the marketplace in your state is run by the federal government, call the customer service line for the patient’s plan. A list of all plans and their customer service numbers can be found in a database on the Healthcare.gov website. A fact sheet for using the database is also available online. If you can’t find the number, you can also call the Marketplace Call Center (1-800-318-2596).
If your state has its own health insurance exchange, you'll need to contact its customer service line. To find the website for your state exchange, select the name of your state in the box at the left hand side of the Healthcare.gov website.
To help both those patients who are new to insurance and your practice, remind them to retain all paperwork they receive from their doctor's appointments, pharmacy visits, and other treatment in case their insurer needs to see it or to support a claim. It may also help to remind them to bring their new insurance card with them to the office. If they don’t have a card, they can contact their plan to get a card.
All patients have until March 31 to sign up for non-employer based coverage to avoid penalties under the Affordable Care Act. They can go to HealthCare.gov to sign up for a plan and apply for financial assistance. Additional fact sheets or educational material for your patients are available through the Centers for Medicare and Medicaid Services website.
– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians
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