Software glitch may have negative consequences for Obamacare

The Patient Protection and Affordable Care Act, also known as Obamacare, is intended to provide healthcare coverage for the uninsured. Before the plan is fully active, the software designed to help the uninsured navigate through the various insurance options and purchase a plan needs to be up and running. According to a recent report by NPR, the software that will be used by many states is struggling to resolve a variety of issues.

Although these issues may not stall Obamacare, it could lead to some headaches for users and healthcare professionals.

At least one prominent program, Connecture, is not yet finished. Designers of the program continue to search for details on the demographic groups that will likely use the program. If the health insurance exchange programs are not up and running by the start date, patients and physicians alike may face struggles.

Insurance exchange program basics

Connecture, like other programs used by Obamacare, is designed to help guide users through the various insurance policies that are available. Reports compare using the program to searching for flights on popular travel sites like Orbit, Travelocity or Kayak. Others clarify that the health insurance exchange program is much more complex than shopping for a flight and may be more akin to filing out taxes, likening the program to a more complex system like Turbotax.

Why is the program more complex? Part of the issue stems back to how the program is run. The program allows each state to have some say in how the program works. Even at the most basic level a state has three different choices on how the program will run. The state can choose to control all the functions, allow the federal government to control the exchange or participate in a partnership with the federal government.

Impact of the program on physicians

Physicians will likely be impacted by the program in a variety of ways, including:

  • Insurance coverage may no longer extend to certain physicians.
  • Physicians may not want to offer coverage to patients using the exchange program. According to a recent report by Forbes, the program will likely pay out lower rates, similar to those received for Medicaid patients.
  • Potential loopholes could leave physicians without payment. As with any new law, loopholes will appear during the early phases. One loophole gaining attention by medical professionals is a provision that allows for care without coverage. This could mean doctors are left without payment for up to two months of care.

If confusions around the new law leads to billing disputes, contact an experienced healthcare attorney to discuss your situation and potential legal remedies.