The initial flow of health insurance claims under the Affordable Care Act was underwhelming.


Affordable Care Act, ACA, health insurance claims, newly insured, ZocDoc.com, Dr. Oliver Kharraz, pharmacies, CVS/pharmacy, Blue Cross & Blue Shield of Texas, drug stores, pharmacists, Brian Lobley, HealthCare.gov








































































































































































































































INSIDE THIS ISSUE
News
Opinion
Other Services
Reprints / E-Prints
Submit News
White Papers

Inside This Issue - News

As ACA kicks in, providers see small uptick in demand

January 20th, 2014

NEW YORK – The initial flow of health insurance claims under the Affordable Care Act was underwhelming.

While more than 2 million people had signed up for coverage under the ACA, demand for care from the newly insured early last month was modest, providers said.

But fears that ACA enrollees would be sickly, with major and costly pent-up medical needs, were apparently unfounded. The needs of the newly covered were typical, according to data from ZocDoc.com, which matches patients with doctors who accept their plans.

ZocDoc founder and chief operating officer Dr. Oliver Kharraz told Reuters that the vast majority of appointments booked by new policyholders were for preventive care, not acute care for an existing illness, which accounted for only 7% of searches. That was comparable to the behavior of ZocDoc’s previously insured users, Reuters ­reported.

The newly covered searched most often for primary care physicians, accounting for more than half of all searches, said Kharraz, followed by obstetricians/gynecologists and dermatologists. That matches the most-searched-for categories for people with non-ACA plans, he told Reuters.

At pharmacies, some new claims filers encountered glitches with their policies. Tony Kouri of Wichita Falls, Texas, went to his local CVS/pharmacy on New Year’s Day for a refill of an asthma inhaler, according to the Wall Street Journal. But the computer indicated he had been enrolled in the wrong Blue Cross & Blue Shield of Texas plan.

He expected to pay the full cost of the drug before reaching his deductible, but the pharmacy said he had a $50 co-pay. Expecting to be billed the difference later, Kouri told the Journal, “There’s some obvious confusion with everyone right now.”

Tim Davis, who owns three drug stores outside Pittsburgh, told the newspaper that a customer who came in January 2 with a card for a new plan couldn’t be found in the system, but the pharmacy gave her a week’s worth of her medication. A few other patients appeared with printouts of their plans and no cards, he said, adding that pharmacists filled their scripts when they could verify coverage.

Reuters reported that insurers had an unusually high number of requests for confirmation of new coverage. Philadelphia-based Independence Blue Cross on New Year’s Day received eight times as many calls as usual from consumers — most often to be assured that they were covered, said Brian Lobley, senior vice president of marketing and consumer ­business.

The company had seen no systemic failure of new policyholders to confirm their coverage, he said.

On the legislative front, the House passed legislation that would require the government to notify Americans within two days if their personal information has been compromised on HealthCare.gov.

Advertisement