I thought this was interesting, in light of how the payment situation with policies is up in the air and not yet resolved with automation yet. Healthcare.Gov still needs to write the code for that part of the website. You can’t really blame the hospitals for coming up with a back up plan of sorts as they don’t want to see any more charity cases than they have to, so yes it would make sense to pay out a couple thousand dollars as an example for surgeries, inpatient services, etc. that are going to run into costs much more than that. If the premiums are paid then the insurer would still have to pay as the patient would be covered.
That might explain a bit more about two big medical centers here in California for stating their own HMO insurance. Sutter was going to participate in the exchanges and then pulled out, and I don’t know the reason why and they may not have been ready to have their own IT infrastructures ready.
Sutter Health Forms New HMO Plan, SignatureValue Alliance and Hires Former OptumInsight (Ingenix-United Healthcare) Executive To Run It
In southern California we have MemorialCare with their Seaside Health Plan. The American Hospital Association doesn’t see an issue and HHS is discouraging this but if the plans are not “federal” there’s nothing stopping such a situation. If the hospital has it’s own HMO then they can managed as needed.
MemorialCare in Southern California Buying Assets of an Existing HMO to Create It’s Own Health Plan Names Seaside Health Plan
This is one way to make sure the insurers keep paying the bills and we won’t really see this happen until things progress a little more with enrollments, etc.
The strategy essentially allows Anthem to rake the Obamacare tax subsidies these low-income buyers will receive over to its side of the table, leaving the hospitals to do the dirty work of collecting bills from hard-up patients.
But hospitals have figured out a way to keep Anthem and other insurers paying the bills on their most expensive patients. They are going to pay the premiums for some of their low-income patients, so the patients’ insurance coverage stays in effect.
This wouldn't apply to the zero-premium plans, which will have the premiums covered entirely by federal tax subsidies. But the hospitals could help patients who opt for other kinds of insurance plans in the exchanges, which do require them to pay some of the premiums out of pocket in exchange for lower deductibles and co-pays.
“HHS has significant concerns with this practice because it could skew the insurance risk pool and create an unlevel field in the [exchanges]. HHS discourages this practice and encourages issuers to reject such third party payments," stated the Q&A document.
The American Hospital Association also noted that the Obama administration had previously indicated that these payments were OK. In a Oct. 30 letter to a Congressman, Health and Human Services Secretary Kathleen Sebelius said the health insurance sold in the Obamacare exchanges is not a federal health care program. That meant that hospitals would not run afoul of federal anti-kickback laws, which prevent them from paying to help a patient obtain a service or items that are paid for primarily by a federal health care program.
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