Sac Bee: Loophole in health care law could stick doctors with tab

Benjamin Norman for The New York Times Patients at the Peekskill center, which may or may not get to keep a $4.5 million federal grant.
Published: Wednesday, May. 22, 2013 – 12:00 am
Last Modified: Wednesday, May. 22, 2013 – 7:59 am

A loophole in California’s upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills.

A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims.

Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation – but insurers are responsible only for the first month.

Doctors say the liability might keep many physicians from participating in next year’s program. A single prostate cancer patient’s course of treatment can cost $93,000, they say.

“I do think there’s legitimacy to their concerns,” said Diana Dooley, head of the state Health and Human Services Agency and a trustee of Covered California, which is implementing the state’s health care overhaul.

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