When Switching ACA Insurance, Understanding Billing Timelines is Crucial

If you’re enrolled in an Affordable Care Act (ACA) health insurance plan, it’s important to understand how billing works when you switch plans. This is especially true if you have any medical expenses before the new plan takes effect.

In a recent case, an individual switched from a public marketplace ACA plan to a company-sponsored ACA plan within a month of an urgent care visit. Unfortunately, the urgent care provider was not billed correctly under the initial plan. When the individual attempted to have the provider bill the new insurance, they were billed for the full amount.

This situation highlights the importance of understanding how billing works when switching ACA insurance plans.

Billing Timelines for ACA Insurance

ACA health insurance plans have specific billing timelines that must be followed. Generally, the insurance company that is in effect on the date of service is responsible for paying the bill. This means that if you switch plans after receiving medical care, the insurance company that was in effect on the date of service will be responsible for paying the bill, even if you have already switched to a new plan.

There are some exceptions to this rule. For example, if you have a high-deductible health plan (HDHP), you may be responsible for paying the full cost of medical care until you meet your deductible. In this case, you may be able to have the provider bill the new insurance company for the amount that exceeds your deductible.

What to Do If You’re Billed Incorrectly

If you’re billed incorrectly for medical care, you should contact the insurance company and the provider immediately. The insurance company will need to review your claim and determine if it was processed correctly. If the claim was processed incorrectly, the insurance company will need to reprocess the claim and send you a corrected bill.

The provider may also be able to help you resolve the issue. They may be able to re-bill the insurance company or provide you with a payment plan.

Tips for Avoiding Billing Issues

To avoid billing issues when switching ACA insurance plans, follow these tips:

Make sure your insurance information is up to date. When you switch plans, be sure to update your insurance information with your providers. This includes your new insurance card and your new policy number.
Keep a record of your medical expenses. This will help you track your expenses and ensure that you’re not billed incorrectly.
Contact your insurance company if you have any questions. If you’re not sure how billing works or if you have any questions about a bill, contact your insurance company. They will be able to help you understand your coverage and answer any questions you have.

By following these tips, you can help avoid billing issues when switching ACA insurance plans and ensure that you’re getting the coverage you need.