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For Your Practice Medicare & Medicaid Public Health

Urgent Message Regarding Private Option Terminations

Aug 19, 2015 3 Min Read

ARK-PO-BETER1News reports have been following the situation of Private Option patients whose coverage has been or will be terminated due to lack of updated income information. There have been major problems in collecting the needed information, compounded by backlogs at local county offices, delayed mail, nondescript envelopes and the short 10-day turnaround. One carrier has at least 20,000 private option enrollees whose coverage terminated on July 31.

AMS, along with the Arkansas Hospital Association, Arkansas Pharmacists Association, DHS and ABCBS have been cooperating on a plan to avoid medical service disruptions for these patients.  It is expected that most of the terminated patients will be reinstated once the income information has been completed and processed. Therefore, ABCBS has proposed and DHS has agreed, that rather than denying claims for non-coverage, ABCBS will begin holding claims for these patients at least until August 31. This will apply back to dates of service beginning August 1.

AMS Advice

  1. Read the full alert on AHIN for a complete explanation of what ABCBS is doing and how it affects your claims.
  2. Check eligibility prior to delivering a service, especially on elective surgeries and services.  AHIN will continue to show the patient’s coverage ended July 31, 2015. Claims will show:
  3. Private Option – Claim on Hold pending eligibility determination by the State of Arkansas.
  4. If the eligibility check shows that the patient was terminated, advise them to verify income for Medicaid or seek subsidized coverage through the marketplace at healthcare.gov. Loss of coverage is a qualifying event for special enrollment period if an application is made within 60 days of loss of coverage.
  5. The decision is yours as to whether or not to continue providing services. However, for patients who are in the middle of treatment, you should consider issues of continuation of care and the potential for patient abandonment, as well.
  6. Understand that there is a risk that a patient who has been terminated may no longer qualify for continued coverage and ultimately result in the claims not being paid. It could be because of a change in income or failure to provide DHS with the requested income information. However, they are likely to qualify for other coverage (see #3 above).

Other Carriers – We are aware that the Arkansas Insurance Department has reached out to the other Private Option carriers to see if they will also agree to this plan. AMS suggests you contact the other Private Option carriers if you have a question about someone’s coverage.