HIMSS News

Premium Collections and Health Insurance Exchanges: Creating Ease of Payment Services

Mike FontanaThe rollout of the mandated marketplaces has been anything but smooth, as you are aware.  Their ability to sign in, access plan information, determine subsidies, and feel comfortable about personal data security have all become issues for potential purchasers of health insurance. What must not be viewed negatively in the experience is the handling of premium payments.

State Exchanges have the option of collecting premium payments directly from purchasers or allowing for direct payments to insurers. This could be for the initial binder payment or for all payments from the buyer. Additionally, convenience fees may be applicable depending on the state. The federally run exchanges have chosen to have payments made directly to the insurers.  Any subsidy(s)portion of the premium, whether state-run, market or federal, is handled directly between the insurer and the federal government.  Individual participations in third party healthcare programs may also add to the complications.

What we have experienced in working with state, federal and private exchanges is that multiple payment types within a single sign-on electronic environment are very important. Additionally, little thought had been given to the unbanked participants initially and how best to work with them. The ability to provide this segment with a walk-in payment option from multiple locations for these individuals allows the Exchanges to collect from the participant segment the ACA legislation was designed to assist most.

Potentially, additional issues will develop for all of the participants along the way including partial payments, multiple payments, payments made to the wrong entity, third party payments, 90-day payment grace period, as well the accounting and return of the payments. These will affect everyone involved in the process, including determining if an individual is covered during an encounter.

These coverage issues will be especially important to the healthcare providers, as they may not know when an individual accesses them and/or whether or not they will receive payment from the insurer. Having additional mechanisms, such as online portals with multi-payments capabilities to receive funds owed by the consumer, and policies in place will be necessary to control a potential increase of bad debt.

Mike Fontana is the Healthcare Industry Manager for Alacriti. Mike has a medical banking background and has served in several areas of responsibility for organizations such as JPMorgan Chase Healthcare and Insurance, MasterCard International Healthcare, Insurance and Charities, as well as in consulting roles.