American Speech-Language-Hearing Association

Verifying Patient Coverage in a Health Insurance Marketplace Plan

(January 6, 2014)

The Centers for Medicare & Medicaid Services (CMS) has announced that, with the beginning of the Health Insurance Marketplace in 2014, providers will be able to verify their patients' insurance status. These new insurance plans are available as a result of the opening of the marketplaces (also known as Exchanges) that are a part of the implementation of the Affordable Care Act (ACA).

Some states' marketplaces are run by the federal government, and some states are running their own marketplaces. The administration of the marketplace in your state will determine who to call for verifying coverage. CMS has provided the following information to assist:

  • If the marketplace in your state is run by the federal government, it is best to call the government plan's customer service line. A list of all plans and customer service numbers can be found online. To use the database, consult the fact sheet [PDF]. If you can't find the number, call the Marketplace Call Center at 800-318-2596.
  • If your state has its own health insurance exchange, contact your state. To find the website for your state exchange, select your state from the drop-down menu.

Background

The ACA offers insurance to individuals who may have previously been uninsured or underinsured, including people who are self-employed or who work for small employers that are not required to provide insurance for their employees. Thus far, 2 million people have enrolled. Many of these individuals may be unfamiliar with health insurance coverage in general, and others may not have received an insurance card yet. For this reason, providers may need to verify coverage prior to rendering treatment. (Note: the information received at these sites will only confirm that a person has coverage, but will not tell you what services will be covered.) For 2014, individuals have the opportunity to sign up for coverage until March 31, 2014, with coverage beginning as early as January 1.

Additional Resources

Potential clients who have not yet signed up for health insurance have until March 31 of this year to sign up.

For more information about the Affordable Care Act, visit ASHA's website or contact Laurie Alban Havens, ASHA's director of private health plans and Medicaid advocacy, at lalbanhavens@asha.org or 301-296-5677.


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