Doctors, hospitals expect some confusion as Obamacare plans start

Credit: Reuters/Kevin Lamarque

A woman fills out her thoughts on the Affordable Care Act at the White House Youth Summit on the Affordable Care Act in Washington December 4, 2013.

More than 2 million people enrolled in private plans offered under the Affordable Care Act, popularly known as Obamacare, during the initial sign-up period for health benefits starting January 1. Enrollment began in October and lasts through March, but Americans in most states had to enroll by last week to get coverage that takes effect with the start of the new year.

The expansion of coverage through the new plans is one of the signature parts of the 2010 law, which is the most sweeping U.S. social legislation in 50 years. Over time, the law - which requires most Americans to buy insurance, offers subsidies to help low-income people get covered and sets minimum standards for coverage - aims to dramatically reduce the number of Americans who lack health insurance, which the U.S. government has estimated at more than 45 million.

After a difficult October launch plagued by problems with the website used to enroll people in coverage, the focus now for the government and healthcare providers has turned to what will happen beginning Wednesday, when patients with the new coverage start to seek care.

At the start, confirming a patient's plan may present headaches for care providers. The Obama administration has acknowledged that errors occurred in transmitting enrollment data to insurers, especially early in the enrollment period.

Although government officials say they have dramatically improved the process, healthcare providers are concerned about problems or delays in verifying coverage with insurers.

'It will be difficult for us to actually verify coverage - that's my concern,' said Dr. William Wulf, CEO of Central Ohio Primary Care, which has 250 primary care physicians.

The task could be made more difficult by decisions by the U.S. government and many states to push back enrollment deadlines toward the end of the year, and to allow some patients well into January to pay for coverage that is retroactive to the start of the year.

The late deadlines mean that many enrollees who seek care initially may lack insurance cards or other proof of coverage.

Wulf said his physician offices will assume that an existing

patient is covered if they claim to be when they come in for appointments and their coverage cannot be verified immediately. But if they require expensive tests, such as MRIs or heart-stress tests that can cost up to $700, the Ohio practice will check with insurers first to make sure the patient has coverage.

Similarly, Dr. Andy Chiou, CEO of Peoria Surgical Group Ltd in Illinois, said that if the practice finds a 'significant minority' of its patients do not have coverage when they believe they do, it might delay elective surgeries for patients until their insurance is confirmed.

'For the protection of patients and us, we'll have to say, 'Sorry, you don't have insurance,'' Chiou said.

POLITICAL STAKES HIGH

For the Obama administration, the political stakes are high in ensuring a smooth transition period for coverage, particularly after the website's problems damaged the popularity of the Democratic president and the healthcare overhaul, his top domestic achievement.

Republicans who have called Obamacare a costly program that will rob many Americans of insurance choices have said they will make Obamacare's problems their top issue in the November 2014 elections, when control of Congress will be at stake.

White House health policy adviser Phil Schiliro said on Tuesday that because of the intense focus on Obamacare, 'problems that have never gotten attention before will get some attention now.'

The U.S. government has tried to anticipate the coverage problems new enrollees might encounter. The federally run Healthcare.Gov website last week posted advice on what enrollees should do if they have not received an insurance card, encounter problems getting coverage for a drug prescription, or need to appeal a decision by an insurer.

'For consumers whose marketplace coverage begins on January 1, we're doing everything we can to help ensure a smooth transition period,' Kathleen Sebelius, the U.S. secretary of health and human services, said in blog posting on Tuesday.

'What we are stressing to folks is that if they get to a provider (and) there is some confusion (about coverage), call their insurer,' Schiliro said. 'If the insurer is not able to resolve it, they should call our toll-free number (800-318-2596) ... and operators will be there 24/7.'

Some healthcare companies are trying to get ahead of potential problems as well.

The pharmacy chain Walgreen Co said on Monday that it would allow consumers who have not yet received a plan identification number from their insurer to get prescriptions at no upfront cost in January, if they can provide evidence of their coverage or pharmacy staff can otherwise confirm it.

Wal-Mart on Tuesday said it would institute a similar practice.

HOSPITALS READY FOR CHANGE

Hospital executives, meanwhile, said they were ready for potential hiccups with the newly insured.

The vast majority of Americans have employer-based coverage and Medicare plans and can choose new plans every January, so executives said the beginning of the Obamacare plans represented a more intense version of an insurance transition period they already are familiar with.

'Hospitals feel like they're pretty well prepared because they've had systems in place and tools in place to work through these sorts of issues,' said Jeff Goldman, vice president of coverage policy for the American Hospital Association. 'We expect an uptick in volume, but we don't think it's anything beyond what most hospitals are prepared to handle.'

As many as 7 million people were expected to sign up for coverage in the Obamacare plans for 2014, but enrollment so far is well short of that figure largely because of the problems with the HealthCare.gov website. Residents of 36 states use the site to enroll; those in the other 14 states use state-run websites. Hospitals, therefore, may have been preparing for more new enrollees than they are likely to see at this point.

At New York's Montefiore Medical Center, staffers were trained on how the new healthcare plans work in part so they can help patients resolve any coverage issues, said Lynn Richmond, the medical center's chief of staff.

'There's not a lot of active worry on our part,' Richmond said. 'We feel ready to manage the hiccups.'

Indeed, many have eagerly anticipated the law's broadening of coverage. Across the nation, hospital operators' finances have been weighed down by patients who have been unable to pay their bills because they lacked sufficient insurance.

'We're looking forward to the first quarter and beyond because we feel we're in a very good position to benefit from the ACA,' said Steven Campanini, a spokesman for Tenet Healthcare Corp, one of the largest publicly traded hospital chains.

(Additional reporting by Susan Cornwell in Washington; Editing by David Lindsey and Jonathan Oatis)