News / USA

Doctors, Hospitals Expect Some Confusion as Obamacare Plans Start

FILE - Doctors confer in the neonatal intensive care unit of the Holtz Children's Hospital at Jackson Memorial Hospital in Miami, Florida.
FILE - Doctors confer in the neonatal intensive care unit of the Holtz Children's Hospital at Jackson Memorial Hospital in Miami, Florida.
TEXT SIZE - +
Reuters
Hospitals and medical practices across the United States braced for confusion and administrative hassles as new insurance plans under President Barack Obama's healthcare law took effect on Wednesday.
 
More than 2 million people enrolled in private plans offered under the Affordable Care Act, popularly known as Obamacare, during the initial sign-up period for health benefits. Enrollment began in October and lasts through March, but Americans in most states had to enroll by last week to get coverage that takes effect with the start of the new year.
 
The expansion of coverage through the new plans is one of the main parts of the 2010 law, the most sweeping U.S. social legislation in 50 years. Over time, the law - which requires most Americans to buy insurance, offers subsidies to help low-income people get covered and sets minimum standards for coverage - aims to dramatically reduce the number of Americans who lack health insurance, which the U.S. government has estimated at more than 45 million.
 
After a difficult October launch plagued by problems with the website used to enroll people in coverage, the focus for the government and healthcare providers has turned to what will happen beginning on Wednesday when patients with the new coverage start to seek care.
 
The law still faces political and legal hurdles. Roman Catholic Church-affiliated organizations obtained last-minute court injunctions on Tuesday that gave them temporary exemptions from a part of the healthcare law that requires employers to provide insurance policies covering contraception.
 
U.S. Supreme Court Justice Sonia Sotomayor granted one temporary injunction to Baltimore-based Little Sisters of the Poor and Illinois-based Christian Brothers Services, plus related entities.
 
The Centers for Medicare and Medicaid Services, or CMS, part of the U.S. Department of Health and Human Services, had 10,000 agents on call for New Year's Eve and New Year's Day to field questions from people dealing with enrollment problems.
 
“We are ready ourselves to assist consumers as well with our full complement of call center representatives available,” said Julie Bataille, spokeswoman for the CMS.
 
At the start, confirming a patient's plan may present headaches for care providers. The Obama administration has acknowledged that errors occurred in transmitting enrollment data to insurers, especially early in the enrollment period.
 
“It will be difficult for us to actually verify coverage - that's my concern,” said Dr. William Wulf, chief executive of Central Ohio Primary Care, which has 250 primary-care physicians.
 
The task could be made more difficult by decisions by the U.S. government and many states to push back enrollment deadlines toward the end of the year. The late deadlines mean that many enrollees who seek care initially may lack insurance cards or other proof of coverage.
 
Wulf said his physician offices will assume existing  patients are covered if they say they are when they come in for appointments and their coverage cannot be verified immediately. But if they require expensive tests, such as MRIs or heart-stress tests that can cost up to $700, the practice will check with insurers first to make sure the patient has coverage.
 
Dr. Andy Chiou, chief executive of Peoria Surgical Group Ltd in Illinois, said that if the practice finds a “significant minority” of its patients do not have coverage when they believe they do, it might delay elective surgeries for patients until their insurance is confirmed.
 
“For the protection of patients and us, we'll have to say,  'Sorry, you don't have insurance,”' Chiou said.

Political Stakes High
 
For the Obama administration, the political stakes are high in ensuring a smooth transition period for coverage, particularly after the website's problems damaged the popularity of the Democratic president and the healthcare overhaul, his signature domestic achievement.
 
Republicans, who have called Obamacare a costly program that will rob many Americans of insurance choices, have said they will make Obamacare's problems their top issue in the November 2014 elections, when control of Congress will be at stake.
 
The U.S. government has tried to anticipate the coverage problems new enrollees might encounter. The federally run  Healthcare.Gov website posted advice last week on what enrollees should do if they have not received an insurance card, encounter problems getting coverage for a drug prescription, or need to appeal a decision by an insurer.
 
“For consumers whose marketplace coverage begins on January 1, we're doing everything we can to help ensure a smooth transition period,” Kathleen Sebelius, the U.S. secretary of health and human services, said in blog posting on Tuesday.
 
“What we are stressing to folks is that if they get to a provider (and) there is some confusion (about coverage), call their insurer,” White House health policy adviser Phil Schiliro said. “If the insurer is not able to resolve it, they should call our toll-free number (800-318-2596) ... and operators will be there 24/7.”
 
Some healthcare companies are trying to get ahead of potential problems as well.
 
The pharmacy chain Walgreen Co said on Monday it would allow consumers who had not yet received plan identification numbers from their insurers to get prescriptions at no upfront cost in January, if they could provide evidence of their coverage or pharmacy staff could otherwise confirm it.
 
Wal-Mart said on Tuesday it would institute a similar practice.

Hospitals ready for change
 
Hospital executives said they were ready for potential hiccups with the newly insured.
 
The vast majority of Americans have employer-based coverage and Medicare plans and can choose new plans every January, so executives said the beginning of the Obamacare plans represented a more intense version of an insurance transition period they were already familiar with.
 
“Hospitals feel like they're pretty well prepared because they've had systems in place and tools in place to work through these sorts of issues,” said Jeff Goldman, vice president of coverage policy for the American Hospital Association. “We expect an uptick in volume, but we don't think it's anything beyond what most hospitals are prepared to handle.”
 
As many as 7 million people were expected to sign up for coverage in the Obamacare plans for 2014, but enrollment is so far well short of that figure, largely because of the problems with the HealthCare.gov website. Residents of 36 states use the site to enroll. Those in the other 14 states use state-run websites. Hospitals, therefore, may have been preparing for more new enrollees than they are likely to see at this point.
 
At New York's Montefiore Medical Center, staffers were trained on how the new healthcare plans work, partly so they could help patients resolve any coverage issues, said Lynn Richmond, the medical center's chief of staff.
 
“There's not a lot of active worry on our part,” Richmond said. “We feel ready to manage the hiccups.”
 
Indeed, many have eagerly anticipated the law's broadening of coverage. Across the country, hospital operators' finances have been weighed down by patients who have been unable to pay their bills because they lacked sufficient insurance.
 
“We're looking forward to the first quarter and beyond because we feel we're in a very good position to benefit from the ACA,” said Steven Campanini, a spokesman for Tenet Healthcare Corp, one of the largest publicly traded hospital chains.

You May Like

Wikipedia Proves Useful for Tracking Flu

Technique gave better results than Center for Disease Control (CDC) and Google’s Flu Trends More

Turkish Law Gives Spy Agency Controversial Powers

Parliament approves legislation to bolster powers of intelligence service, which government claims is necessary to modernize and deal with new threats Turkey faces More

Video Face of American Farmer Changing

Average American farmer is now 58 years old, and farmers 65 and older are the fastest growing segment of the population More

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Face of American Farmer is Changingi
X
Mike Osborne
April 18, 2014
The average American farmer is now 58 years old, and farmers 65 and older are the fastest growing segment of the population. It’s a troubling trend signaling big changes ahead for American agriculture as aging farmers retire. Reporter Mike Osborne says a new report from the U.S. Census Bureau is suggesting what some of those changes might look like... and why they might not be so troubling.
Video

Video Face of American Farmer is Changing

The average American farmer is now 58 years old, and farmers 65 and older are the fastest growing segment of the population. It’s a troubling trend signaling big changes ahead for American agriculture as aging farmers retire. Reporter Mike Osborne says a new report from the U.S. Census Bureau is suggesting what some of those changes might look like... and why they might not be so troubling.
Video

Video Donetsk Governor: Ukraine Military Assault 'Delicate But Necessary'

Around a dozen state buildings in eastern Ukraine remain in the hands of pro-Russian protesters who are demanding a referendum on self-rule. The governor of the whole Donetsk region is among those forced out by the protesters. He spoke to VOA's Henry Ridgwell from his temporary new office in Donetsk city.
Video

Video Drones May Soon Send Data From High Seas

Drones are usually associated with unmanned flying vehicles, but autonomous watercraft are also becoming useful tools for jobs ranging from scientific exploration to law enforcement to searching for a missing airliner in the Indian Ocean. VOA’s George Putic reports on sea-faring drones.
Video

Video New Earth-Size Planet Found

Not too big, not too small. Not too hot, not too cold. A newly discovered planet looks just right for life as we know it, according to an international group of astronomers. VOA’s Steve Baragona has more.
Video

Video Copts in Diaspora Worry About Future in Egypt

Around 10 percent of Egypt’s population belong to the Coptic faith, making them the largest Christian minority in the Middle East. But they have become targets of violence since the revolution three years ago. With elections scheduled for May and the struggle between the Egyptian military and Islamists continuing, many Copts abroad are deeply worried about the future of their ancient church. VOA religion correspondent Jerome Socolovsky visited a Coptic church outside Washington DC.
Video

Video Critics Say Venezuelan Protests Test Limits of Military's Support

During the two months of deadly anti-government protests that have rocked the oil-rich nation of Venezuela, President Nicolas Maduro has accused the opposition of trying to initiate a coup. Though a small number of military officers have been arrested for allegedly plotting against the government, VOA’s Brian Padden reports the leadership of the armed forces continues to support the president, at least for now.
Video

Video More Millenials Unplug to Embrace Board Games

A big new trend in the U.S. toy industry has more consumers switching off their high-tech gadgets to play with classic toys, like board games. This is especially true among the so-called millenial generation - those born in the 1980's and 90's. Elizabeth Lee has more from an unusual café in Los Angeles, where the new trend is popular and business is booming.
Video

Video Google Buys Drone Company

In its latest purchase of high-tech companies, Google has acquired a manufacturer of solar-powered drones that can stay in the air almost indefinitely, relaying broadband Internet connection to remote areas. It is seen as yet another step in the U.S. based Web giant’s bid to bring Internet to the whole world. VOA’s George Putic reports.
AppleAndroid