Wednesday, November 13, 2013

Obamacare lets you stiff the doctors

What happens if you sign up for Obamacare, pay the first month's premium and then don't pay any more premiums?  You get an additional 3 months of coverage for free.  The insurance company pays for the first additional month, and doctors and hospitals are on the hook for the next two months.  I'm sure they will be thrilled with that knowledge.

Here is the language:
45 CFR 156.270 - Termination of coverage for qualified individuals.
(d) Grace period for recipients of advance payments of the premium tax credit. A QHP issuer must provide a grace period of three consecutive months if an enrollee receiving advance payments of the premium tax credit has previously paid at least one full month's premium during the benefit year. During the grace period, the QHP issuer must: (1) Pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period; (2) Notify HHS of such non-payment; and, (3) Notify providers of the possibility for denied claims when an enrollee is in the second and third months of the grace period.

Note: To "pend claims" means to delay paying them until a later date. A pended claim may ultimately be paid, reduced, or denied.

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