additional actions on the part of providers,” he added. The Blues and Aetna say they instituted notification measures to help physician practices cope, along with other educational resources to inform patients of their obligation to pay their premiums. (See “90-Day Notice,” page 19.) Dr. McCoy adds physicians may notify Blues patients that if their coverage terminates at the end of the grace period, they are responsible for payment, up to the billed charges. He cautioned, however, that “our provider contracts require the provision of services to members and prohibit advance pay- ment for such covered services except for member’s required cost sharing, if any.” Because of contract requirements like these, TMA officials
urge physicians to scrutinize their contract obligations sur- rounding the marketplace plans. TMA also warns that CMS advises against paying patients’ premiums on their behalf. Read more in TMA’s exchange plan Q&A for physicians, www
.texmed.org/ExchangeQA.
Bright spots on the horizon Amid the murky marketplace, some bright spots are emerging.
Dr. Aventa says he received timely payments for some of
the exchange patients he treated. And in Nacogdoches, Ms. Barnhart says the Blues PPO network appears to have a “good panel” of doctors. For all the complexity, Dr. Chenven adds more patients are coming in with health insurance. “Would it be nice if we could do this without these transi- tion difficulties? Sure. And I’m sure in time this will all get fixed. Meanwhile, despite the inconvenience of the transition for both providers and patients, there are a lot more people protected with health care.”
CMS says it plans to engage physicians to address any is- sues. As part of that effort, Dr. Farris told physicians at the TMA Winter Conference the agency wants to hear from physi- cians about their experiences with marketplace health plans. AMA is helping to collect that information from state and spe- cialty medical societies, as well as medical practices, to take back to CMS in hopes of resolving problems promptly. Email your feedback to
ExchangePlans@ama-assn.org. n
Amy Lynn Sorrel is associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
April 2014 TEXAS MEDICINE 25
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