AHA: Hospitals Can Pay Patients' HIX Premiums

Cheryl Clark, for HealthLeaders Media , November 18, 2013

America's Health Insurance Plans, the lobby for the insurance industry, could not be reached for a comment.

Who Gets Help with Premiums?
How hospitals or their doctors might decide which patients to cover is the tricky part, and up for debate.

Currently, patients who enroll in health insurance exchanges have to pay their premium bills within 90 days. If they don't, and the hospital or clinic that provided care that was reimbursed, the health plan has the right to "claw back" those funds, in effect reverting the patient to uninsured status. The hospital then may be forced to go after the patient separately, a time-consuming and often unsuccessful effort.

Some have suggested that the precedent has already been set, because government agencies now allow third parties to pay COBRA premiums, for example, as a benefit for employees who voluntary take buyouts from their companies in downsizing strategies.

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3 comments on "AHA: Hospitals Can Pay Patients' HIX Premiums"

Stuart Showalter (11/25/2013 at 11:08 AM)
The AHA advisory is basically their advocacy position. It remains an open question whether subsidizing an insured's premium would be a violation of the kickback laws (state or federal) or some other anti-fraud statute. Regardless of the opinion of AHA, HHS or the DOJ, it would ultimately be for the courts to decide. Using a charitable foundation may be an option, but I urge careful legal analysis on a case-by-case basis.

Martha Carlton (11/19/2013 at 3:07 PM)
How is this different from healthcare systems offering HMO policies through HIX for $1 per month? As long as the patients can choose where they access it seems like a in- win.

Manuel H. Moraleda (11/19/2013 at 11:26 AM)
Ultimately this money that the hospital is using comes from insured patients. Would the federal government provide a bailout later in the event that the insurance company is placed at financial risk and would consider bankruptcy ?




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