January 2014 starts a new paradigm for practices and their patients. The introduction of insurance exchanges brings new opportunities and risks for practices. On the upside it is very likely that a brand new set of patients will start seeing providers in a much more proactive manner. These patients may have insurance for the first time, or may be coming of more traditional employer sponsored health insurance. So what’s the risk?
There are new risks associated with eligibility although those practices that are familiar with state sponsored plans like Medicaid will be familiar with some of the issues. Since this is patient paid insurance there is a risk of having an eligibility check show as “active” when the patient is in the grace period, or that time when they are past due for paying their insurance premium. Practice’s may face services that go unpaid with little or no protection from either the health plan or the government.