As part of the Affordable Care Act, the federal government adjusts reimbursements to health-care providers up or down based on the quality and cost-effectiveness of their services, as measured by a set of standards established by the Centers for Medicare and Medicaid Services (CMS). The standards use metrics such as how long emergency-room patients must wait to be seen and how long it takes heart-attack victims to get stents placed in their blocked arteries. The intention is to encourage savings and sound practices and enhance patient satisfaction.
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Meg and Robert Holub were surprised to receive a letter last week welcoming them to a new health insurance plan and telling them to pay $3,483 by Jan. 8.
“We have received your application for individual and family coverage effective 1/1/2018,” the letter said. The only problem: They never applied for the coverage, did not want it and could not afford it.
“I worried, did someone hack my account to sign me up for this?” Mr. Holub said. “And I wondered, what are the implications if I don’t pay for this plan? Will I be hounded by a credit agency?”
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