Millions of dollars have been lost due to a bureaucratic oversight.
A patient walks into a doctor’s office. The doctor’s office contacts the insurance company. The insurance company states that the policy for the patient is active. The doctor sees the patient. It turns out the patient needs surgery. The surgery is scheduled. The doctor’s office verifies the insurance again. The insurance company says again that the policy is active for the patient. The doctor performs the surgery. The doctor’s office then files a claim to the insurance company, asking to be paid.
The insurance company doesn’t pay a dollar.
Why? Because the patient stopped paying their insurance. There is currently a ninety-day loophole when a person with ObamaCare is considered active even though they are delinquent on their payments. So, when the doctor’s office calls the insurance company and the insurance company says that the policy is active they’re being honest. The policy is active because they are expecting to be paid the back payments by the patient. But, because they end up not getting paid by the patient, the insurance company doesn’t have to pay the doctor’s office who filed a claim.
So, what happens?
Doctors and hospitals have lost money. A lot of money. In South Florida alone this has been in the realm of millions of dollars. Doctor’s offices and hospitals have tried contacting patients, encouraging them to pay their backdated insurance, but the patient usually doesn’t. Either they can’t because they were too poor to keep up with their payments to begin with or they won’t because they already got the surgery.
Doctor’s offices and hospitals turn to debt collectors, but their recovery rate is a joke. Roughly 15-23% is the national average, which leaves a deep hole in the pockets of the medical industry.
A Local Group has the Answer.
Health Insurance Restoration Project operating out of Lantana has put forward a nominal solution to a massive problem. It seems too simple, but this plan has started to show real promise.
Pay the insurance.
The Restoration Project is contacted by a doctor’s office or hospital that let’s them know of a claim that was denied by an insurance company because of delinquent payments. The Restoration Project contacts the former patient and asks permission to pay their back payments to the insurance company. There’s no problem for the former patient in doing so because it removes the debt collector who is asking for the cost of the entire surgery. If there is a copay that’s owed it’s certainly less than the cost of the entire surgery AND the former patient has more time to pay the copay before that’s deemed late.
Once the insurance is active and paid for, the doctor’s office resubmits the claim and it’s paid by the insurance company.
Why doesn’t the doctor’s office just pay for the insurance?
Because it’s illegal. The only reason the Health Insurance Restoration Project can do it is because they are a third party and it helps that they are a non-profit group, though they do get paid. They would have to if they wanted to keep doing what they’re doing. Rather than get paid by the patient or some charitable donation that would eventually be limited, the Restoration Project gets paid by the doctor’s office, receiving a percentage of what is being paid to the doctor’s office from the insurance company.
There’s definitely money to be gained at the hands of the Restoration Project, but that doesn’t mean they won’t be helping a lot of people.
Some speculation has been concerned if this would damage the risk pool that insurance companies use to determine premiums. The question being, would this cause premiums to go up for everyone? Most experts are saying no because the typical equation that is being used to determine premiums are based on the likelihood of a person getting sick verse not sick, not whether they will pay or not pay. So, basically this is stopping insurance companies from getting bonuses, not keeping the bread off their table.
Delinquent payments has caused massive layoffs at locals hospitals because no one anticipated this unique kind of problem with ObamaCare. In fact, one former employee now works at the Health Insurance Restoration Project in an effort to fix the system that failed him.
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