Does new health care insurance increase the risk of disputes?

As might be expected, there are a few growing pains associated with the Affordable Care Act. The website issues have been documented in the media, but a lesser-known problem involves unfamiliarity with new procedures applicable to both doctors and patients.

As in other insurance dispute contexts, the starting point for resolving disputes is often an examination of the applicable contractual terms. Under the Affordable Care Act, patients have expressed confusion over some of those procedures, especially Medicare beneficiaries who might be accustomed to a different approach.

One solution favored by the Obama administration is to have doctors coordinate the care of such Medicare beneficiaries. Under existing approaches, patients with chronic illnesses may receive disjointed care from a patchwork of different providers. According to a recent estimate, around 70 percent of the 54 million Medicare patients are still in a fee-for-service arrangement; the remaining patients are in H.M.O.s or private health plans.

However, there may be additional potential for disputes. Medicare wants doctors to use electronic records, for example. Given the substantial number of retirement communities in Florida, compliance with new contractual requirements under the Affordable Care Act may be a concern of many hospitals, clinics, physicians or other health care providers.

If disputes do arise between those providers and insurance companies, it is advisable to consult with a health insurance claim attorney. An attorney can review the contractual terms and provide advocacy through any of the required venues, which may include mediation, arbitration or even litigation and appeal. An attorney can work to help health care providers recover compensation for any services they provided.

Source: The New York Times, “Medicare to Start Paying Doctors Who Coordinate Needs of Chronically Ill Patients,” Robert Pear, Aug. 16, 2014

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