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Jan. 9 Issue of AIS Newsletter Identifies Top Challenges for Exchanges in 2014

Washington, DC (PRWEB) January 15, 2014

A year ago, Atlantic Information Services, Inc.’s (AIS) Inside Health Insurance Exchanges (HEX) predicted that if everything went “according to plan,” 2013 would be the year that exchanges transition from policy to actuality, with fully functional state and federally facilitated exchanges (FFEs). But things didn’t go exactly as planned, and for its Jan. 9 issue HEX interviewed industry observers on the future of exchanges. These observers, including health care lawyers, consultants, former exchange officials and policy advisors, identify 12 challenges that public exchanges, insurers, agents and consumers will face in 2014.

The main challenge will be overcoming the “early chaos” of the newness of the marketplaces, recent policy changes and deadline extensions to pay premiums. Early implementation problems will include: people who thought they enrolled but never paid the premium and do not have coverage; people who enrolled and paid, but have no proof of coverage when they arrive at a hospital or doctor’s office; people who think they enrolled but their information was lost by the exchange; and people who enrolled, but didn’t understand elements of their coverage (such as the lack of out-of-network coverage, deductibles or coinsurances). Linda Tiano, a member of the health care and life sciences practice at the law firm Epstein Becker and Green, suggests this chaos will subside, however, after the next few months.

The second challenge will be insurer participation. Despite the lackluster enrollment in year one, carriers already participating on public exchanges are likely to continue for the 2015 plan year, suggests Rosemarie Day, president of Day Health Strategies and former chief operating officer of the Massachusetts exchange. “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.”

Visit to read the full list of challenges, including provider access, billing snafus and more.

About Inside Health Insurance Exchanges
Inside Health Insurance Exchanges provides hard-hitting news and strategies on the details of federal, state and private health insurance exchanges, for business planners with health plans, hospitals and health systems, medical groups, ancillary providers, suppliers, pharma companies and state health policy makers. The biweekly newsletter answers questions about this cornerstone of the health reform law — who will participate, what product designs will look like, the effect on enrollment and more. Subscribers receive reliable intelligence on how to make the most of the enormous transformation in health insurance that is about to unfold and how to succeed in the insurance marketplace of tomorrow. Visit for more information.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

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