What Physicians Should Expect From Patients with ACA Insurance

Affordable Care Act Plan LevelsHealthcare consulting encompasses a wide range of areas, as consultants are able to advise physicians when it comes to billing, managing accounts, credentialing, and much more. It also helps physicians understand their patients and how changes in the healthcare system affect the patient and the practice.

The Affordable Care Act (ACA) is one of those changes that have happened recently with many individuals enrolling, many maintaining their existing insurance if they could, and some taking advantage of Medicare expansion in their states.

What we are going to look at is the employer-based healthcare market and the employees spending their own money versus those receiving rich plans for less because the employer pays part of the plan. It is expected that employee choice and responsibility will increases because of ACA, but employer administration may decrease. The question is whether or not this is going to happen within the next three years or ten years. Most experts believe it will be two to four years. The change will be a fast one, accelerated by the public exchange market and the laws surrounding it.

The Paradigm Shift

It is expected that there will be a paradigm shift in how employees choose their plans and then make the final selection. All of this will affect how they use them, especially since the plan that is chosen will determine how much insurance pays and how much it doesn’t. It has already been found that employees will almost always select plans that are of a lesser value than what their employers were already providing before ACA. Employees will simply buy down when they have to spend their own money, which is not surprising at all.

The result is a higher out-of-pocket liability at the point of care. This is something that providers must be aware of since higher patient liability results in more money that the practice has to collect directly from the patient in addition to collecting from the insurance company. This could end in more unpaid bills and a bit more order in regards to managing patient accounts. This is an area where healthcare consulting comes in. You do have to ensure that your billing is in check so that you can get the most out of your collections activities.

Evolution of Benefits Consulting

The area of healthcare consulting that involves benefits is benefits consulting. It is getting to the point that patients need to know what they are looking at in regards to cost and this is causing many physicians and their staff to consult with their patients about that cost.

An example of why patients need to be informed is this: A patient had to have a growth removed. It was an approximately 30 minute outpatient surgery, but it was his first opportunity to test the quality of his insurance. He thought he was spending the insurance company’s money and not his, despite the high deductible of $3,000. He more or less blindly went into the procedure to pay whatever was charged with the mindset it wasn’t his money. What he found out was that it was his money. He was not sure what was or was not necessary in the surgery or what his options were as far as payment. Now he is having difficulty paying the bill because the out-of-pocket was not much more than the deductible. His only option is to make payments when the practice has no payment plans on balances owed.

Taking this scenario from a different angle, the surgeon’s office could have called and asked for a $500 deposit. This is something that is happening more now that billing departments are paying attention to insurance plans. However, the surgeon and the facility may call, asking for a deposit up front for a specific cost.

The Takeaway

The changes in the market will cause there to be changes in how billing is dealt with, as well as the cost and quality of information. Even patients are going to have to look at the questions that they ask, but physicians need to be partners in their recommendations. There is a lot of potential for improvement in the healthcare sector. Healthcare consulting can help with this, as well as a thorough understanding of the Affordable Care Act.


For any billing-related matters, MD Pro Solutions can help you with compliance, account management, and billing practices that will help you secure your bottom line. To learn more, call us at 508-946-1665 or fill out our contact form.