This is an interesting question. And, of course, we hope the answer is Yes.
But, there are two elements of the Affordable Care Act (ACA) that may actually dis-incent doctors from accepting patients whose insurance comes from the exchange.
- Premium Grace Period – Under the ACA, insured individuals will be given a three-month grace period during which their coverage remains in force, even if the premiums are not paid. The insurance companies will delay claims processing for the first two months that premiums are not paid, but by the third month, the insurer will deny any claims, forcing the physicians to try to recoup their costs directly from the patients. Under traditional plans, the doctor still gets paid even if premiums have not been paid.
- Lower Reimbursement Rate – Doctors may be paid less per visit from the insurance company for patients under exchange plans versus those in employer-sponsored or private plans.
There is a third factor that may doctors may consider when deciding whether or not to accept patients under an exchange plan. The population of exchange shoppers are more likely to be those individuals who were previously uninsured. And, without prior insurance, they are more likely to have have unattended-to medical issues, making their care more complex.
We hope that the physicians’ lobbyists and interest groups are able to communicate these issues and make some changes before the Act is implemented. Otherwise we may be facing a provider shortage.
