Obamacare Rule will Stick Doctors with Unpaid Bills

Doctors worry they won't get paid by some patients because of an unusual 90-day grace period for government-subsidized health plans. 

So several professional groups for doctors are urging their members to check patients' insurance status before every visit. Consumer advocates say these checks could lead to treatment delays or denials for some patients.

If a person with subsidized insurance falls behind in paying the premiums, the Affordable Care Act requires insurers to cover his medical bills for 30 days. 

But for the next 60 days, insurers can hold off paying those claims — and ultimately, deny them if the patient doesn't pay the premiums in full. An insurer's denial means doctors don't get paid for their services. If the insurer ends up canceling the policy after 90 days, doctors can bill patients directly but may face difficulty collecting. 

"This puts the physician and their patients in a very difficult situation," said Dr. Ardis Dee Hoven, president of the American Medical Association, which advised physicians Wednesday about how to minimize their risk.

"If a patient is being treated for a serious illness that requires ongoing care, the physician is having to assume the financial risk for this," she said. "That's the bottom line." 

The way things work now, insurers generally cancel a policy if a subscriber falls behind more than 30 days. The insurer is usually on the hook for bills incurred before that cancellation.

The AMA and dozens of other physician groups have urged the administration to spell out how and when insurers must notify physicians when their patients fall behind on premiums.

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