Three-month Grace Period Under the ACA & Texas Law

Brett Johnson, JD, MPH, MS

 Brett Johnson, JD, MPH, MS

By: Brett Johnson, JD, MPH, MS, Center for Medical and Regulatory Policy, California Medical Association, Sacramento, CA

Providers are continuing to face uncertainty concerning whether they will get paid during the Affordable Care Act's three-month grace period, which allows a patient to go three months without paying premiums. 

Some commercial health insurance plans with exchange products in Texas have expressed an interest in creating an escrow-type account to hold provider payments associated with unpaid patient premiums.  The Texas Department of Insurance (TDI) is exploring the issue, but they are unlikely to do much more.

Providers will counter that the health plans should not treat the qualified health plan (QHP) exchange plans any differently than other commercial health insurance products: If a premium has lapsed, pay the provider claims with a remark code nothing that it is in "audit."

We'll keep you updated on this issue and how the ACA three-month grace period applies to the Texas prompt pay laws.

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