Hospitals are defending their practice of holding patients accountable for paying their medical bills in the face of confusion over Obamacare coverage in the the new year.
The problem-riddled rollout of healthcare.gov forced the Obama administration to extend deadlines for enrollment. Insurers, unprepared for the delays, couldn't process all of the applications quickly enough for consumers to pay their first month's premium and receive their insurance cards by Jan. 1.
The backlog of enrollments is creating confusion for those who signed up for insurance on the federal exchanges late in December but have no way of proving they have coverage when they go to the doctor or pharmacy.
Under federal law, hospitals must stabilize and treat people who come to them for emergency care, regardless of their insurance status or ability to pay. But many medical situations fall into a gray category outside the law -- situations where care may not be required but could help a patient.
A spokeswoman for Inova hospitals in Alexandria, Va., which provides medical services for more than two million people in Northern Virginia, said their policies haven't changed from Dec. 31 to Jan. 1.
The group of hospitals will stabilize and treat any patient suffering from an emergency medical situation whether they have insurance or not. For anything beyond an emergency, however, patients can decide to accept care, and Inova will try to bill the insurance company first.
If the insurer cannot verify that someone enrolled and paid their first month's premium and denies the claim, the patient will be responsible for any medical bill.
“You have to agree to pay your portion — that would happen to anybody — regardless of whether they [obtained insurance on the federal health care exchange] or not,” a spokeswoman said.
Many — but not all — insurance companies are trying to make it easier for recent enrollees to gain coverage by extending the deadline to pay their first month's premium for a week, or in some cases, until the end of the month.
As long as consumers make the new deadline for paying their first month's premium, they can go to a doctor or pharmacy in the interim and have their medical care and prescriptions covered.
Some pharmacies, such as Walgreens and CVS, are taking the unprecedented steps of providing January prescriptions for customers who signed up for health plans on the federal exchange even if they have yet to receive their insurance cards or pay their first month's premiums.
Walgreens spokeswoman Markeisha Marshall said they are urging new Obamacare enrollees with no plan identification to bring information about the coverage they signed up for to the pharmacy. The pharmacy teams will then check their eligibility with insurers or “work with patients to confirm that they've enrolled” through the Affordable Care Act.
“If we cannot locate plan information, but can confirm that the patient is enrolled through the healthcare marketplace, we will provide up to a 30-day prescription,” she said, adding that Walgreens understands that it is doing so at “our own risk.”
The Obama administration has spent the last week touting the late surge in sign-ups that has brought the total number of Obamacare enrollees to 2.1 million and highlighting positive anecdotes from those who have benefited from the law.
They have declined to say how many Americans have actually paid their premiums and have downplayed the early January confusion over coverage.
“Like any transition such as occurs every year when people move from one type of [insurance] plan to another type of plan, there is some confusion,” White House spokesman David Simas told reporters on a conference call Thursday.
“We require a lot of communication between pharmacists, doctors and providers and that type of coordination is ongoing and we will continue to ramp up over the next week,” he added.