CHA News Article

AHA Member Advisory Focuses on New Insurance Coverage Issues
Highlights issues related to eligibility, benefits, networks and financial considerations

The American Hospital Association today released the attached member advisory titled Understanding and Monitoring New Insurance Coverage Issues. The advisory highlights potential issues related to uncertainty that may occur as newly covered individuals begin to seek coverage under the Affordable Care Act (ACA) and suggests how hospitals may respond. Important areas of focus are eligibility, including presumptive eligibility under the ACA; benefits; networks; and financial considerations.

While hospitals have worked through coverage issues with patients and insurers for many years and have processes in place to assist patients with enrollment issues, AHA advises that, this year, hospitals need to be even more diligent in training front line staff and working with insurance companies and the marketplaces to verify patient eligibility, determine benefits and networks, and advise patients on their financial responsibilities under their plan. For example, for patients whose eligibility cannot be confirmed at the point of service, hospitals should advise them of their options, including how to get coverage or how to find out if they qualify for charitable care programs. AHA notes that, most importantly, hospitals need to ensure that patients are able to get needed care during this transitional period. 

The Centers for Medicare & Medicaid Services (CMS) has asked AHA to collect feedback from hospitals across the country so that it can help to resolve the issues encountered by hospitals and health systems. AHA has developed a form that hospitals can use to document issues and concerns they are experiencing. The member advisory also includes links to several CMS fact sheets for assisting consumers and providers with plan-specific information.