Linda Tiano Quoted in “Enrollment Confusion, Provider Access, Billing Snafus Will Dominate News in 2014”

AIS's Inside Health Insurance Exchanges

Linda Tiano, a Member of the Firm in the Health Care and Life Sciences practice, in the Washington, DC, and New York offices, was quoted in an article titled "Enrollment Confusion, Provider Access, Billing Snafus Will Dominate News in 2014."

Following is an excerpt:

Through telephone and email interviews conducted by HEX, industry observers were generally optimistic about the future of exchanges, but warned of myriad obstacles ahead that could cause the exchange train to go off the tracks. ?...

Given the newness of the public marketplaces — combined with recent deadline extensions to pay premiums — quite a bit of "early chaos" is expected, says Linda Tiano.

She suggests this chaos will subside, however, after the next few months. ?...

"It's still a bit of a leap of faith for them," she says, noting that carriers will have little claims data to help them set prices when they file their 2015 products this spring. "They've invested a lot already to enter the exchange marketplace, and won't want to throw that away just yet. But that's as long as the requirements from exchanges don't get more onerous, and that things start to smooth out operationally." ?...

Providers will "continue to aggregate at a very fast pace, both to work on care integration but also to attempt to compete with narrow network plans that might exclude them," by establishing either accountable care organizations (ACOs) or their own managed care plans, Tiano suggests. ?...

In the early days of managed care, many plans had limited networks that didn't cover services from out-of-network providers. That led to disputes and a significant amount of litigation over whether a carrier could be required to cover out-of-network providers, says Tiano.