Obama administration puts more pressure on health insurance companies…

… to solve the problems created by the Obama administration and Obamacare. Back on Dec. 6 I wrote about the provision in Obamacare that might leave doctors and health care providers in a position where they are told a patient has coverage, but they end up not getting paid. Now, but Obama administration is pressuring insurance companies to pay for procedures and care even if no premiums have been paid.

As usual, the document is hard to read, but I’ve tried to pluck out the most important parts. Because of the “delays,” the Department of Health and Human Services wants coverage for those who select plans after Dec. 23 and before Jan. 31, 2014 to be retroactive to Jan. 1, 2014 even if no premiums have been paid.

SUMMARY: This interim final rule amends the date by which a qualified individual must  select a qualified health plan (QHP) through any Exchange for an effective coverage date of January 1, 2014. This rule generally allows consumers to select a QHP until December 23, 2013, which is a change from the previously stated regulatory date of December 15, 2013, but permits State Exchanges to select a different date. It also establishes a related policy regarding the date by which a consumer needs to pay any applicable initial premium to ensure timely effectuation of coverage. This rule pertains to the individual market and Small Business Health Options Program in both the Federally-facilitated Exchanges and State Exchanges. This rule does not change the plan selection or premium payment dates for coverage offered outside of the Exchanges.

Since the publication of the Exchange Establishment Rule and the Draft Enrollment Guidance, there have been unforeseen barriers to enrollment in the Exchanges.

No kidding?

In §155.410(c)(1)(v), this rule states that the Exchange may allow issuers to provide for a coverage effective date of January 1, 2014 for plan selections received after December 23,2013 but on or before January 31, 2014, if a QHP issuer is willing to accept such enrollments. We note that if the QHP issuer allows enrollment in January for a January 1 coverage effective date, any services provided to the enrollee in January would need to be covered retroactively as if the enrollee had been enrolled from January 1. QHP issuers in an FFE will have this option, and while we understand that late enrollment may create challenges for issuers in processing the premium payments and providing retroactive coverage, we urge issuers to consider a January 1, 2014 coverage effective date for plan selections after December 23, 2013 for this year, given the newness of the enrollment process.

Remember, there is also a 90-day grace period before insurers can drop patients who fall behind on premiums. Then there are out-of-network issues. In general, policy dates are not in-line with the dates agreements are made between physicians and other health care providers. A network agreement between a hospital and an insurance company can end at any time. During the negotiations, and insurance company would send a letter to members letting them know there might be a future issue, but the plug can be pulled at any time. The HHS is strongly suggesting the insurance companies cover care by out-of-network providers if the provider was listed as in-network at the time of enrollment. This is not how it’s usually done.

For those directories that cannot be maintained in a current status, we believe that it would be reasonable for issuers to consider services received out-of-network as having been received in-network (subject to in-network coverage and cost-sharing standards) with respect to any provider listed in the version of the provider directory as of the date of that enrollee’s enrollment for the beginning months of coverage. We strongly encourage issuers to adopt this approach.

Huh. “Strongly encourage…” We all know what that means when it comes to this administration.

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Steve McGough

Steve's a part-time conservative blogger. Steve grew up in Connecticut and has lived in Washington, D.C. and the Bahamas. He resides in Connecticut, where he’s comfortable six months of the year.


  1. Dimsdale on December 13, 2013 at 9:49 am

    Leave it to the “evil” insurance companies to cover (and take the blame) for the incompetence of this regime.

  2. bien-pensant on December 14, 2013 at 4:35 pm

    The regime has kept up a steady stream of blame, denial — it’s NOT in Egypt! — and fixes. Dates of promised full functionality have come and gone. There is no embarrassment in announcing the latest “cure” for Obama’s signature failure. This one is to hang any liability on the insurance companies, regardless of their real fiduciary responsibilities.
    On the regime’s relentless march to the single payer system, this is another irrevocable step to driving all insurance companies OUT of the health insurance market.

  3. Lynn on December 15, 2013 at 7:56 am

    Ok, I’ll be the Grinch. When I sold health insurance I had the utmost respect for insurance companies. For the most part, they were fair. I won’t names but there are two, I still hold in high esteem, mostly because they refuse to enter the exchanges. However, the insurance companies ?made a pact with the devil AKA, Obamacare. They greedily joined the fight for this monstrosity. My contempt also goes to the AMA, Hospitals, unions of medical personnel, AARP and all others who did not understand the bill and pushed the passage. ?I wrote to AMA in particular begging them to fight this bill. They did eventually see the light, but by then it was too late. ?my only pity goes to those people who have lost their insurance, especially my former clients.?

    • sammy22 on December 15, 2013 at 2:11 pm

      Lynn, I agree with you.

    • Lynn on December 15, 2013 at 9:53 pm

      Thank you

    • JollyRoger on December 16, 2013 at 3:13 am

      I wouldn’t blame hospitals or medical personnel- except maybe the guys in suits with business degrees. ?Is there any other industry that’s mandated to serve everyone regardless of ability to pay? ?I blame the pols who never fail to exploit these issues and everyone who votes for them.

    • Lynn on December 17, 2013 at 8:36 am

      I agree it’s the suits, but at the Town Hall to discuss different plans there were at least 60 people who came wearing their “Healthcare Reform Now” shirts. I was told they were union members thinking that their ranks would be increased by unionizing all who worked in hospitals. ?I could be wrong, but their cheerleading at a Town Hall led Rep. Joe Courtney to believe and to show on TV that there was support for an Obamacare bill.

  4. SeeingRed on December 16, 2013 at 8:14 am

    What part of this is NOT the nationalization of the healthcare insurers/payers???Are we?Venezuela ALREADY?

    • bien-pensant on December 16, 2013 at 6:02 pm

      O and crew are getting us there, slowly but surely. After the messed up roll out, I think, my guess is anyway, that the regime’s thinking is to make the health care issue so emotional and toxic that everyone will be begging for the government to take it over.
      Venezuela by any other name will still mean nationalized health care for the US, ergo, Obama’s and the lefty liberals’ dream.
      The question then becomes, what sector of the economy will the regime plot to take over next?

    • sammy22 on December 17, 2013 at 11:36 am

      I don’t know about you SeeingRed, but I send my check to UnitedHealthcare, not the Federal Government. I believe that the healthcare sector is firmly in the hands of the insurance companies.

    • Lynn on December 17, 2013 at 11:57 am

      Only until the insurance co can’t afford to pay the high cost to insure the sick without having a larger pool of healthy people to offset cost. That is simple economics. The healthy (read young people) are not going to buy the Obamacare policies because there are so many mandates in the policy they can’t afford the policies. Again, simple economics. Besides I sold policies directly targeted to self employed business people and the vast majority of young people, just starting new jobs or their own business, couldn’t even afford them. The end result, if the ridiculous mandates ?in the policies are not taken away allowing for free choice, this will cause health insurance companies to go broke or the govt will subsidize them. This will cause insurance co to not care how high they will price premiums, again simple economics. Voila, single payer govt healthcare.?

    • sammy22 on December 17, 2013 at 12:05 pm

      We’ll have to wait and see how this all works out.

    • Dimsdale on December 18, 2013 at 9:31 am

      We know how it is going to work out (and so does the regime): you will send bigger and bigger checks to UH because of feel good unfunded mandates by the incompetents in the federal government.? Virtually every one of the predictions of failure for this crap sandwich law has come, or will come true.? Everything the “arsonists” and “terrorists” (definitions of the critics of this lousy law) claimed has quietly passed under the bridge until it hits an abutment.
      The biggest lie of the? year: if you like your health care plan you can keep it.? Period.
      Simple economics is too simple for the do-gooders in the government.? There is always plenty of someone else’s money.

    • sammy22 on December 18, 2013 at 12:05 pm

      Dims, I agree w/ you on the biggest lie of the year. I also still resent having to pay for the healthcare of those who either do not have health insurance or, worse, refuse to buy it and leave me (and you) holding the bag. If the latter group showed more personal responsibility, Lynn’s dire predictions may not even be a consideration.

    • Lynn on December 18, 2013 at 5:48 pm

      You missed my point, people are willing to buy insurance, but a policy they choose. Congress wrot a lousy healthcare plan, that is why no one wants to buy it. Choice, choice, choice, that is my point

    • sammy22 on December 18, 2013 at 6:38 pm

      Sorry if I missed your point, Lynn, but I do not think so. Even if there was choice, choice, choice and more choice, I would not expect to read anything non-negative about anything (save maybe on preexisting conditions)? about Obamacare on this blog.

    • Lynn on December 19, 2013 at 7:00 am

      Yes, that is true. The only place you will find positive comments on Obamacare ?is on the Obamacare websites and on the state exchange websites. Oh and maybe the diehard Congress members who passed it who are NOT running in 2014.

    • Lynn on December 19, 2013 at 7:14 am

      Oh and Drudge Report has a fascinating article about a Wednesday Night Event which will provide positive commentary on Obamacare?http://www.nationalreview.com/corner/366636/drag-queens-promote-obamacare-alec-torres

    • bien-pensant on December 19, 2013 at 8:48 am

      If a giraffe is the product of a committee trying to design a dog, then ObamaCare is the result of the liberals designing health care insurance for everyone. It is larded with all kinds of political payoffs to various left leaning interest groups. In that result is gifts to the feminists, the LGBTs and single moms, which constitutes the base of the democrat party.
      If anyone resents paying extra for their new and improved health care, let them know where the extra on their premium is going.
      It is odd that I don’t see anything for groups like gun owners, single men, veterans or religious groups. Oh, that’s right, they get to pay more for all of the services they don’t want or need or will ever use — but, they are there.

    • Dimsdale on December 19, 2013 at 8:55 am

      Sammy: I, too, “resent having to pay for the healthcare of those who either do not have health insurance or, worse, refuse to buy it and leave me (and you) holding the bag.”? But we all know that the fact that we did, and still do (think illegals) is the result of other feel good legislation that requires hospitals to care for anyone, repeat, anyone that comes into the emergency ward with no regard to their ability to pay, hence, the buck passes to us.? That could have been fixed (yet again) by simply amending that trash legislation to include a means of getting the treated to pay up whether insured or not.? A hospital lien would have been a good start.? All ?bamacare does, with its new mandated “standards” is make the fact that we are paying for others look more official.? It is all crap, and served in a crap sandwich by our incompentent legislators that never think a problem through to its logical and inevitable end.? ?bamacare a case in point.

    • Dimsdale on December 19, 2013 at 9:00 am

      And why would you expect to read something positive about a poorly written, unread-before-being-voted-upon, politically motivated legislation rammed through Congress and across the preezy’s desk by a series of lies, substitutions, backdoor deals and sleazy tactics?? Did I mention lies?
      If it was so damn good, it wouldn’t need all the subterfuge, delays, waivers and special mandates, would it?

    • Dimsdale on December 19, 2013 at 10:47 am

      I forgot: ?bamacare is poorly executed as well.

    • sammy22 on December 19, 2013 at 11:56 am

      Read an interesting article today about “junk insurance” and how some people got caught having to pay huge healthcare bills, were forced into bankruptcy etc. I know, these are isolated cases in the otherwise splendid system we had/have.

    • Lynn on December 19, 2013 at 4:25 pm

      Sammy interesting point. However, the insurance companies in CT, at least, are very tightly regulated by the state. There is very little fraud here. I can’t say about other states, but of course you gave no specifics or link to your “interesting ?article”. This is of course a great tactic of people to disparage Big Bad Insurance Companies. They forget that there is fraud in ?advisors to buy stocks, used car salesman, phony preachers, charities which give ?huge salaries to the directors and little to help anyone, Congressmen who ?get more and more perks on our dime and can do insider trading, President Obama, Moveon.org, Organizing for America, ACORN, navigators for Obamacare etc. etc. So what is your point?

    • sammy22 on December 19, 2013 at 6:35 pm

      Lynn, the story is by Tony Pugh out of DC and the insurance company identified as selling junk insurance is HealthMarkets Inc. out of TX, w/ subsidiaries in various states. Even the AG of MA took on HealthMarkets Inc. Maybe CT is a state w/ impeccable credentials in this area. Perhaps other states are not so “caring” and there? is a world beyond CT. But what’s the difference: just read what Dims has posted above.

    • Dimsdale on December 21, 2013 at 1:16 pm

      But isn’t the fraud rampant in Medicare/caid, a “splendidly” run government healthcare program.? With all the loopholes, waivers, game playing and politicking, I would not have trouble calling ?bamacare junk insurance.? Like gambling, just because the gov’t does it, doesn’t make it right.

    • sammy22 on December 21, 2013 at 5:07 pm

      You can have the last word, Dims. But, because you say it doesn’t make truthful.

    • Dimsdale on December 21, 2013 at 9:38 pm

      Well, if you have evidence that the existing government healthcare programs aren’t rife, I daresay riddled, with fraud, by all means present it.? I can be convinced.? Otherwise, what I say is truthful.

  5. bien-pensant on December 19, 2013 at 6:39 pm

    It has been said by me before and I will say it again: the largest growth industry under Obama has been corruption.
    Gee, Wally, wasn’t some HARTFORD charity busted today ‘cuz it had no assets and hadn’t awarded any scholarships or paid any bills (‘cept’n the only employee) in a very long time? I don’t understand where the money could’a gone??? LINK: Doc Hurley . . .

  6. bien-pensant on December 21, 2013 at 8:50 am

    Then, we have yesterday’s move by the Obama regime that effectively delays the individual mandate. That was the 14th such change to the law since October.
    Didn’t the Republicans ask for a one year delay? They were called names by the democrats. Not nice names, either.

    • Dimsdale on December 21, 2013 at 1:17 pm

      At least they weren’t called Democrats.? Or liberals….

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