ON AIR NOW

LISTEN NOW

Weather

cloudy-day Created with Sketch.
82°
Mostly Cloudy
H 88° L 66°
  • cloudy-day Created with Sketch.
    82°
    Current Conditions
    Mostly Cloudy. H 88° L 66°
  • cloudy-day Created with Sketch.
    68°
    Morning
    Mostly Cloudy. H 88° L 66°
  • cloudy-day Created with Sketch.
    82°
    Afternoon
    Mostly Cloudy. H 87° L 66°
LISTEN
PAUSE
ERROR

Krmg news on demand

00:00 | 00:00

LISTEN
PAUSE
ERROR

Krmg traffic on demand

00:00 | 00:00

LISTEN
PAUSE
ERROR

Krmg weather on demand

00:00 | 00:00

New ACA insurance causes headaches in some doctors' offices

Sheila Lawless is the office manager at a small rheumatology practice in Wichita Falls, Texas, about two hours outside of Dallas. She makes sure everything in the office runs smoothly – scheduling patients, collecting payments, keeping the lights on. Recently she added another duty--incorporating the trickle of patients with insurance plans purchased on the new Affordable Care Act exchanges

Open enrollment doesn’t end until March 31, but people who have already bought Obamacare plans are beginning to use them. “We had a spattering in January—maybe once a week. But I think we’re averaging two to three a day now,” says Lawless. 

 That doesn’t sound like many new customers, but it’s presented a major challenge: verifying that these patients have insurance. Each exchange patient has required the practice to spend an hour or more on the phone with the insurance company. “We’ve been on hold for an hour, an hour and 20, an hour and 45, been disconnected, have to call back again and repeat the process,” she explains. Those sorts of hold times add up fast. 

>> Read more trending stories  

In the past, offices have been able to make sure patients are insured quickly, by using an online verification system. But for exchange patients, practices also have to call the insurer to make sure the patient has paid his premium. If he hasn’t, the insurance company can refuse to pay the doctor for the visit, or come back later and recoup a payment it made. 

That’s because of a provision of the law that gives exchange patients who neglect to pay their premium a “grace period” of up to 90 days. During the first 30 days, insurers have to pay any claims incurred by the patient. But for the next 60 days, nothing is guaranteed. If the patient visits the doctor, the insurer can “pend” the claim – that is, wait to pay the doctor until the patient pays his premium. At the end of the 90-day grace period, if the patient has not paid the premium, the insurer can cancel the coverage and refuse to pay the pended claims, or recoup the payments it’s already made.  And that puts the doctor’s office at risk. 

So Lawless is checking first with the insurer to make sure that everything is in order before proceeding with the visit. If the premium has not been paid, Lawless gives the patient the option of rescheduling the appointment or paying in cash and then applying to his insurer for the payment. 

“Most small practices run lean and mean – you’ve got one or two people to do this process plus do their other job duties that day as well, which is tend to the patients in front of them,” says Lawless. To manage the new workload, she’s had other staffers, including nurses, step in to answer the phone. And that means longer hours, more overtime, and higher overhead expenses. And then there’s the plain old annoyance factor. 

“You call in and you hit option prompts and you get to listen to no less than an hour of Blue Cross Blue Shield intro music. I could sing you the tune, that’s how often I’ve had to listen to it,” she says. “My staff said yesterday, it’s a sad shame within their prompts you can’t pick your music as well. If you’re going to have to wait that long, at least let us listen to what we want to listen to!” 

Blue Cross Blue Shield in Texas is the only insurer offering exchange plans in Wichita Falls. Dr. Dan McCoy, the company’s chief medical officer, says part of the problem was the health law’s compressed timeline. 

“Clearly at the end of December there were a significant number of members that enrolled and it’s taken some time to work through that volume in membership,” explains McCoy. “And we know this is a new day in the transformation of American health care. So it’s going to take a little bit of time to work through that.” 

Health Care Service Corp., which owns Blue Cross Blue Shield of Texas, has tried to address the situation by adding another 600 employees at its call center to handle the influx of calls and by extending business hours. McCoy has also been working directly with the Texas Medical Association to work out the kinks. 

Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association in Washington, D.C., a trade group for practice administrators, says the real problem is that signing up for coverage on the exchange isn’t as simple as the White House has made it sound. 

“What we’ve found is that messaging out of the [Obama] administration right now that’s aimed at the public, it tends to oversimplify the complexity of what it takes to get covered on the exchanges,” says Gilberg. “Just because you enrolled in coverage doesn’t mean your coverage is effective.” 

Even if patients pay their premium right away, it could be up to six weeks before their coverage actually starts. To have insurance start at the beginning of a month, the coverage generally must be purchased by the middle of the previous month. A plan purchased on Feb. 14 would be effective March 1. But a plan purchased on Feb. 16, for example, would not become effective until April 1. Go to the doctor before then, and your insurer doesn’t pay. 

“It’s not a surprise that given the subtle nuances and differences of what these exchange products are, that you’re in a gray area right now where there’s a little confusion on the patient side and the practice side. And I think that’s what we’re seeing a lot of right now,” says Gilberg. 

For a brand new program, that’s to be expected, he adds. And it doesn’t mean the exchange isn’t working. The real test will be what happens in April, when open enrollment ends and everyone who has purchased a plan offered through the health law’s online exchanges plan is clearly covered. 

In the meantime, Lawless offers this advice to patients who have bought plans on the exchange: “If you pay your premium prior to [visiting the doctor], print that out and bring it with you because that will certainly save all a lot of grief.”

Read More
VIEW COMMENTS

There are no comments yet. Be the first to post your thoughts. or Register.

  • Almost everywhere I went this weekend and ran into someone I knew, there was one question asked by just about everyone – whether it was at the pool, on the golf course, or grilling burgers in my back yard – “Will the Republicans get their health care bill through the Senate this week?” Let’s take a look at what the GOP has to do to get that bill approved. 1. A test for the Senate Majority Leader.  The hamburgers had barely touched the grill on Sunday evening, when my father – a veteran of many legislative showdowns on Capitol Hill – asked whether I thought the GOP could get the health bill approved in the Senate by the end of the week. My answer is much like where we were with the House bill at the beginning of May – I can see the GOP passing this by the narrowest of margins, and I can also envision the bill getting delayed because of concerns among GOP Senators.  Remember, the House had a couple of false starts before finally mustering a majority for the Republican health plan. Senate Republicans face key week as more lawmakers waver in support for health-care bill — devcode88 (@devcode88) June 26, 2017 2. President Trump warming in the bullpen.  Just like he did when he cajoled reluctant Republicans in the House to get on board with a GOP health care plan, the White House has already had the President reaching out to GOP conservatives who aren’t quite sure they really want to vote for this overhaul of the Obama health law. Over the weekend, the President again made clear – that despite concerns over individual provisions in the bill, and how it might change health insurance options in the individual market – this is better than the current Obamacare situation. Expect to hear that argument a lot more this week from the White House. I cannot imagine that these very fine Republican Senators would allow the American people to suffer a broken ObamaCare any longer! — Donald J. Trump (@realDonaldTrump) June 24, 2017 3. There really is no role for Democrats. Just like in 2009 and 2010 as the Obama health law made its way through the House and Senate – when Republicans did not have the votes to leave their imprint on the bill – Democrats are simply on the sidelines, as they lob verbal grenades at the GOP on an hourly basis. It’s important to remember this week that Republicans have almost no margin for error, as just three GOP Senators could tip the balance of this debate if they refuse to back the Republican health bill. All Democrats can do is watch from the sidelines, and hope they have an impact. We got the Senate bill text on Thursday. This bill would overhaul our entire health care system but the GOP wants to vote next Thursday! — Dick Durbin (@DickDurbin) June 25, 2017 4. Have you read the bill? Why not? The GOP health bill is just 142 pages long – but even if you sit down to read it, I guarantee that most of you won’t be able to figure out what it says. Why? Well, that’s because it is basically an amendment to the underlying Obama health law, and if you don’t have that language on hand, you won’t really know what the Republicans are trying to change, and how. The original Affordable Care Act was well over 2,000 pages long – and the reason that this GOP bill is so short is simple – it just amends the Obama health law – this is not “repeal and replace” by any measure. Because it leaves most of Obamacare in place. https://t.co/8lnG9385JU — Bill Kristol (@BillKristol) June 25, 2017 5. The GOP Senators who might vote ‘No.’ If I had to list a group of Republicans to watch, my morning line would look this way: I WILL SAY THIS SENATOR IS OPPOSED TO THE BILL 1) Rand Paul – most likely to vote “No” at this point 2) Dean Heller – Nevada Senator said on Friday that there must be changes POSSIBLE NO VOTE 3) Mike Lee – said this weekend he thinks the bill doesn’t significantly reform health care. But I still wonder if he gets to “Yes” with some late changes. 4) Susan Collins – CBO report is important, plus Planned Parenthood. Still not sure she votes “No.” 5) Lisa Murkowski – Planned Parenthood & bill details important. Important one to watch. CONSERVATIVES ON THE FENCE 6) Ted Cruz – Yes, I know Cruz has said he has concerns. So did the Freedom Caucus in the House, but most of them ended up voting for the bill. 7) Ron Johnson – Same thought for the Wisconsin Republican as Cruz. Can’t see either of them being the 51st vote against the bill. 8) Bill Cassidy – No matter what he said to Jimmy Kimmel, I still think it is unlikely that Cassidy votes against the Senate bill. But we’ll see. Latest whip count on #SenateHealthCareBill: 45 yea 55 nay @GOP opposed: Paul, Cruz, Lee, Heller, Johnson, Cassidy, Collins. — KOMO Newsradio (@komonewsradio) June 25, 2017 Clearly, the GOP leadership – and the White House – has some legislative arm twisting to do in coming days. If this plan stays on track, it could well be voted through on Thursday or Friday.  And if that happens, I wouldn’t rule out the GOP thinking about bringing it right to the floor of the House for a final vote. But we’ll see if we actually get that far.  Stay tuned.  It will be a very interesting week in the halls of Congress.  
  • If you have outdoor plans for today, there will be no need to keep your eyes on the sky. National Weather Service Meteorologist Mark Plate says conditions will remain pleasant throughout the day in the Tulsa area. “It should still be a pretty nice day,” Plate said.  “Partly cloud skies, with the high temperature in the upper 80s.  Relatively low humidity values and light winds.” The low Sunday night will be around 63 degrees. We’ll see more of the same to start the work week.  NWS reports sunny skies though Wednesday and highs will remain in the upper 80s.  
  • If you’re carrying trafficking amounts of drugs, it’s probably not a good idea to drive through a police barricade.   Rufus Newsome learned that lesson the hard way Saturday night, when he reportedly drove through a barricade at the Tulsa officer-involved shooting scene.  This happened around 9:35 p.m., near 3rd and Garnett.  Police say Newsome was driving at a high-rate of the speed after passing the barricade and could have hit multiple pedestrians.  Eventually, he stopped and tried his luck on foot.   “Caught the suspect and the suspect resisted by pulling his hands away,” police said.  “As he was in custody, he spit two times on (officer’s name redacted).” Officers recovered a trafficking amount of cocaine base.   Newsome has been booked into the Tulsa County Jail.  
  • A suspect is dead, following an officer-involved shooting Saturday night near 4th and Garnett. Tulsa police report a pursuit stopped in the area and a suspect tried to flee on foot.   KRMG’s told he ran to a home, tried to kick in the door and then reportedly pulled out a gun.  During this time, he was shot by officers.   Neighbors we spoke to were concerned because they weren't sure what had happened. “All of a sudden we heard the gunshots,” a witness said.  “We didn’t know what was going on.” So far, no names have been released. We do know the suspect was said to be riding in a stolen car. KRMG will update the story when more information comes into the newsroom.
  • Responding to concerns about personal security for lawmakers after last week’s gun attack at a Congressional baseball practice, U.S. House leaders are moving to provide extra money to members for protection back home, as well as new funding to bolster the work of police and security officials on Capitol Hill. Under a plan approved by a House spending subcommittee on Friday, the Congress would provide an extra $7.5 million next year to the Capitol Police for an “increased security posture” around the Capitol, along with $5 million to the House Sergeant at Arms to help with security for lawmakers back in their districts. “We are taking a new fresh look at security,” said Rep. Kevin Yoder (R-KS), the Chairman of subcommittee that deals with funding for the Legislative Branch. Our FY18 Legislative Branch funding bill increases efficiency & transparency in Congress, enhances security for Members & our constituents. pic.twitter.com/FI36tF2XeH — Rep. Kevin Yoder (@RepKevinYoder) June 22, 2017 “The tragic events of June 14 weigh heavily on these deliberations,” said Rep. Rodney Frelinghuysen (R-NJ), the Chairman of the House Appropriations Committee, which could vote on the extra money as early as this next week. Also being put into motion is a separate plan to funnel an extra $25,000 to each member of the House – about $11 million in all – to help them increase security back in their districts. “The scariest part for us is there used to be this impression by the public that we all had security everywhere we went,” said Rep. Tim Ryan (D-OH). “Now, everyone knows that isn’t the case,” Ryan added, as he lent his support to the extra funding for security as well. The money in this budget bill would not take effect until the new fiscal year – which starts October 1 – so, House leaders are ready to okay extra money immediately for members worried about security back in their districts. Roll Call newspaper reported that could be approved in coming days by the House Administration Committee. Yoder said Congressional leaders are also waiting to see if money raised in campaign contributions for House elections could be put to use for security as well. “Pending an FEC (Federal Election Commission) decision, we’re also looking at whether campaign funds could be used to continue to support security upgrades at personal residences,” Yoder added.