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Monday, October 14, 2013

BUT WHAT WILL THE EXCHANGE PLANS PAY?

As the health insurance marketplace created by the Affordable Care Act (ACA) stumbled through its second week of operation, TMA fielded numerous calls and emails from physicians concerned about the particulars. It’s important to remember that these are private health plans — not government-run payers — so there will be no national or statewide fee schedule once the plans start operating on Jan. 1. Your contracts with these insurance companies — existing contracts or new ones for the exchange plans — will determine how much you get paid. So far in Texas, Blue Cross and Blue Shield of Texas (BCBSTX) is the only insurer we know of that has offered new contracts for the exchange plans. BCBSTX created new networks for its exchange products and sought agreement from physicians through separate contracts. But we don’t know what network BCBSTX will use. It may use its established network for some products and the new network for others. TMA will continue to monitor the marketplace in the marketplace. We also continue to produce our weekly “Hey, Doc” series to give your patients no-nonsense answers to their questions about this program. This week we explore who can enroll in the marketplace plans. We’ve also posted a new question-and-answer handout, Who Can Enroll, Who Must Enroll, What Happens If You Don’t Enroll.

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