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For providers, new health care plans check out OK so far

The Obama administration, insurers and health care providers offer these tips for the newly insured:

» Before going to the doctor or pharmacy, get your insurance card or a temporary card with your new plan’s information.

» Make sure you know your payment due date and pay the premium by that date.

» Before scheduling an appointment, make sure the provider is in your network.

» If you don’t have your card yet, ask your insurer to provide another way to confirm your coverage, and ask your doctor or pharmacy what other proof of insurance they will accept.

» If you have a high-deductible, out-of-pocket insurance plan, talk with the health care provider before receiving services to get an estimate of your costs and complete payment arrangements to prevent surprises later.

» If you thought you enrolled in a health plan but aren’t showing up in the system, call your insurer. If you don’t know the contact information, call the Health Insurance Marketplace Call Center at 800-318-2596, and a representative can provide it.

— Francine Knowles

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Updated: February 13, 2014 6:24AM



Consumers had to slog through the trouble-filled launch of the HealthCare.gov website, but Chicago-area health care providers say it’s been smooth sailing so far as they start treating those who have enrolled for insurance under the Affordable Care Act.

“We have not experienced any significant issues or glitches,” said Brian Washa, Evanston-based NorthShore University HealthSystem’s senior vice president of business services.

That mirrors the experience in these early days at Elk Grove Village-based Alexian Brothers Medical Center and Hoffman Estates-based St. Alexius Medical Center, Chief Financial Officer Sherri Vincent said. “We have been able to verify their insurance coverage online. We have not had any problems.”

Health care providers say they can help consumers address coverage verification issues, which have been expected after the scramble by many to enroll by last month’s deadline, following problems with the HealthCare.gov website.

Jan. 1 was the effective date for coverage for those who enrolled in the new federal and state insurance marketplaces by Dec. 24 and who paid for coverage by Jan. 10. Most insurers recently extended the Jan. 10 date, ranging from Jan. 14 to Jan. 31, to give consumers more time to pay.

For coverage starting Feb. 1, insurance seekers must enroll by Jan. 15 and pay their required premium by the insurers’ designated time, which can be no earlier than Jan. 31. Open enrollment for coverage this year ends March 31.

Providers said patients who have not received their insurance identification cards and for whom coverage can’t immediately be verified won’t have to pay in advance for services. But patients ultimately could be billed directly if found not to have coverage.

“If a patient does not have an insurance ID card, we will work with the patient to secure electronic confirmation from their insurance carrier or via the HealthCare.gov website or a conference call to confirm the status,” said Susan Clarke, executive director of patient access at Advocate Health Care, the largest health care system in Chicago and statewide.

“Our trained financial counselors will assist patients by . . . also determining any rules the insurance company has for authorization” and “can help them understand their financial obligation and assist with setting up payment arrangements if needed.”

At VNA Health Care, which has facilities in Aurora, Bensenville, Bolingbrook, Carol Stream and Elgin, patients lacking ID cards “can expect to be seen by [a] medical provider,” spokeswoman Amy Downing said. “If the patient can provide VNA staff with their group policy number and the insurance carrier, VNA will try to verify their coverage. If they cannot provide the information, they will be billed.”

Once coverage has been verified, the insurer will then be billed, she said.

NorthShore’s Washa noted that for elective services, patients could face upfront costs if coverage can’t be verified. “The individual should expect either a request for a deposit or we will possibly elect to reschedule the visit.”

Insurers are typically contacted in advance of such appointments if NorthShore staff believes the insurer requires precertification or coverage is unclear, he said.

Major drugstore chains, including Walgreens and CVS, have said in some instances they’ll make limited supplies of medicines available to customers who bought insurance through the public marketplaces.

Deerfield-based Walgreen Co., the nation’s largest drugstore chain, has said customers who have not yet received a plan ID number from their insurer can receive, through the end of this month, a 30-day supply of medicine at no upfront cost.

Customers will need to bring documentation of their enrollment to the pharmacy. Walgreens’ staff will review patient benefits and work with the patient’s insurance company to confirm benefit eligibility, the company said.

Walgreen, which operates more than 50 Healthcare Clinics in the Chicago area, will give the same help to patients seeking care at the clinics, Walgreen spokesman James Cohn said. “We would seek reimbursement later.”

“At this point, we’ve seen only moderate activity” from newly insured customers, Cohn said, adding that a surge is anticipated sometime this month.

Health Care Service Corp., the largest health insurer in Chicago and the operator of Blue Cross and Blue Shield plans in five states, has experienced a surge in volume at its call center amid the influx of new enrollees and changes in the health care industry, spokeswoman Lauren Perlstein said. The insurer has added 700 call center employees, extended call center hours and started a new billing and payment hotline to assist plan members, she said.

Email: fknowles@suntimes.com

Twitter: @KnowlesFran



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