Many people have had their coverage cancelled by health insurance companies. Last October, Florida Blue cancelled the policies of more than 300,000 customers (80% of its individual plans) on the grounds that the plans did not meet the requirements of the Affordable Care Act.
According to the law, policies sold in the individual market as of January 1, 2014 should have covered the following benefits:
- Doctor visits
- Emergency and hospital services
- Maternity and newborn care
- Mental health and substance abuse treatment
- Prescription drugs
- Rehabilitation
- Chronic disease management
- Laboratory work
- Pediatric services
Individual policyholders across the country were hit. The government soon announced coverage options for consumers with cancelled plans. Consumers have till March 31 to sign up for coverage effective in 2014.
Resources Available for Consumers with Cancelled Health Plans
A cancelled plan can be replaced or renewed. Consumers with cancelled plans can
- Buy another plan that the company offers in its place
- They can look for another suitable health insurance plan in a healthcare exchange. Healthcare exchanges help those
- Who do not have a policy
- Who already have a policy, but want a better option
- Buy a plan outside the Marketplace
The five categories of health insurance plans available in the marketplace are:
- Silver: Plan pays 70%. Customer pays 30%.
- Platinum: Plan pays 90%. Customer pays 10%.
- Bronze: Plan pays 60%. Customer pays 40%.
- Gold: Plan pays 80%. Customer pays 20%.
Catastrophic Coverage
If the plans available in the Marketplace are not affordable, it may be possible for the consumer (if eligible) to purchase catastrophic coverage at the standard price quoted by the insurance company. This can be done by filling out the hardship exemption form available at the CMS website. The consumer has to also explain about the policy cancellation and indicate that the options available in the health exchange are not affordable. This form has to be then submitted along with a copy of the cancellation notice to an insurance company that offers catastrophic coverage in the area and apply for the plan.
What this Means for Healthcare Providers
As insurance companies cancel coverage, health insurance verification becomes even more important to avoid claim rejection. Most medical billing problems and insurance denials occur because insurance benefit information was not verified before services were provided. The typical reasons for denials are
- Member coverage terminated or not eligible for this date of service
- Services are not authorized
- Services are not covered by plan
- Maximum benefits have been met
Benefit verification services are available to help physicians verify everything from patient policy status effective date, type of plan, coverage details to payable benefits, exclusions, co-pays, and co-insurance, referrals and pre-authorizations, deductible, life time maximum and more.
