Doctors' Offices Get Put On Hold Trying to Find Out Who's Insured : Shots - Health News Verifying that a patient has paid for coverage under the Affordable Care Act can take hours. But if doctors' offices don't check, they can get stuck with the bill.
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Doctors' Offices Get Put On Hold Trying to Find Out Who's Insured

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Doctors' Offices Get Put On Hold Trying to Find Out Who's Insured

Doctors' Offices Get Put On Hold Trying to Find Out Who's Insured

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We have heard about some of the challenges people faced when sighing up for coverage under the Affordable Care Act. Now we're in the next phase. People who have their coverage have been heading to doctors' offices and emergency rooms trying to use it. In Texas it is doctors' offices who are reporting some challenges. Employees at those offices are spending a lot of time on hold. Reporter Jenny Gold explains.

JENNY GOLD, BYLINE: Sheila Lawless runs 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 patients with Obamacare plans into the practice.

SHEILA LAWLESS: We had a spattering in January - maybe once a week. But I think we're averaging two to three a day now.

GOLD: It doesn't sound like much, but it hasn't been easy. In the past, offices have been able to make sure patients are insured quickly online. But for exchange patients, practices also have to call to make sure the patient has paid his premium. If he hasn't, the insurance company can refuse to pay or can come back and recoup the payment to the doctor under a provision of the law. So the practice has to check first with the insurer.

LAWLESS: 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. Those hold times can add up fast. Most small practices run lean and mean - you've got one or two people to do this process plus do the rest of their job duties that day as well, which is tend to the patients that are in front of them.

GOLD: Lawless has had to have other staffers, including nurses, step in to answer the phone. And that means longer hours, more overtime, and higher overhead expenses.

LAWLESS: 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.


GOLD: My staff jokingly 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. Chief Medical Officer Dan McCoy says part of the problem was the health law's compressed timeline.

CHIEF MEDICAL OFFICER DAN MCCOY: Clearly at the end of December there were a significant number of members that enrolled and it's taking some time to work through that volume in membership. And we know that this is a new day in the transformation of American healthcare.

GOLD: Blue Cross Blue Shield has tried to address the situation by adding another 600 employees at their call center to handle the influx of calls, and by extending their business hours. The problem is that signing up for coverage on the exchange isn't as simple as advocates have made it sound, says Anders Gilberg, who works at the Medical Group Management Association, a trade group for practice administrators.

ANDES GILBERG: Just because you've successfully enrolled in coverage doesn't mean your coverage is effective.

GOLD: Even if the patient pays their premium right away, it could be up to six weeks before their coverage actually starts. Go to the doctor before then, and your insurer doesn't pay.

GILBERG: You're in a grey area right now, where there's a little confusion on both the patient side and the practice side. And I think that's what we're seeing a lot of right now.

GOLD: For a brand new program, that's to be expected, he says. And it doesn't mean the exchanges aren't working. In the meantime, Sheila Lawless offers this advice to Obamacare patients when they go to the doctor.

LAWLESS: If you pay your premium prior to, print that out and bring it with you because that will certainly save all a lot of grief.

GOLD: For the practice and the patient. For NPR News, I'm Jenny Gold.

GREENE: And Jenny's story is part of a partnership with Kaiser Health News, a nonprofit news service.

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