Practices still struggling to get payments from failing insurance co-ops

March 22, 2016

By Mick Raich, President, Vachette Business Services

Recently, it was noted by Healthcare Finance News that many of the non-profit health insurance co-ops developed under Obamacare have failed to the tune of $1.2 billion.  Yes, this is over a billion dollars lost, never to be seen again.

  • Health care providers throughout the country are owed more than $700 million for services provided to patients of these failed insurance co-ops — the vast majority of which they likely will never see.
  • This makes it more crucial then ever to ensure your practice is diligently tracking payments from co-ops you are contracted with.

Where did this money go? Well, it didn’t go to our clients. Many of our groups are owed substantial amounts of money from these failed ventures. For example, the Kentucky Health Co-Op currently is not paying its claims at all. As the practice manager for this client we reviewed the contract and found we cannot balance bill the patients for this service and that the plan is basically bankrupt. So if the providers didn’t get the money, where did it go?

The government planned on some of these co-ops failing, but they failed at a rate four times higher then they predicted.  Is anyone going to be held accountable for this? And what about the people who signed up for these plans? Some estimates say 740,000 people lost their initial plans and had to sign up for other plans. What about the inconvenience for these people?

There is more than $700 million owed to providers for these services which will never be paid. How do you run a business if you don’t get paid when you deliver services?

Who is investigating this for your practice? Why not hire an expert? Call Stark Medical Auditing/Vachette Business Services at 517-486-4262 and ask for Mick Raich. Or, email Mick at mraich@vachettepathology.com.

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