Hospitals and medical practices across the United States are bracing for confusion and administrative hassles as new insurance plans under President Barack Obama's healthcare law take effect on Wednesday.
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 Jan. 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.