4 Steps to Control Health Care Costs

Learn how predictive analytics can save self-funded employers on health care costs. “We must turn to non-claims data to supplement claims information in search of prospective risk. Predictive analytics providers such as DataSmart Solutions have observed that statistically-proven non-claims data and historical claims information can be combined to produce powerful tools to detect near-term […]

By | 2018-02-06T13:52:24+00:00 December 1st, 2017|2017 News|

Mercer’s Mike Sinkledam Reminds Calendar Year Plans to Implement New SBC Requirements During This Year’s Open Enrollment

“While ‘not a lot has changed from last year, from a compliance standpoint, when it comes to open enrollment, the new Summary of Benefits and Coverage (SBC) template and uniform glossary need to be implemented during this year’s open enrollment for calendar year plans,’ according to Mike Sinkeldam, a principal for Mercer’s Health and Benefits […]

By | 2017-11-29T10:18:53+00:00 November 20th, 2017|2017 News, News|

What to Do When You Receive an Out-of-Network Shakedown Letter

“A physician-owned, out-of-network health care service provider – such as an ambulatory surgery center or a sleep center – sends a demand letter to the plan administrator. The letter asserts an appeal of a denied benefits claim by one of the plan’s participants; requests copies of a lengthy list of plan-related documents; and alleges that […]

By | 2017-11-14T08:18:13+00:00 November 13th, 2017|2017 News, News|

IRS Draws Line in the Sand, Won’t Accept Individual Tax Returns Without ACA Information

“For the first time, an individual must complete line 61 (as shown in previous iterations) of the Form 1040 when filing his/her tax return…. It is reasonable to assume that an employee is more likely to inquire as to the whereabouts of the ACA information necessary to complete his/her 2017 tax return. Therefore, the possibility […]

By | 2017-10-30T06:59:55+00:00 November 6th, 2017|2017 News, News|

Telemedicine Expanding Rapidly

“According to one recent survey, telemedicine services (i.e., remote delivery of healthcare services using telecommunications technology) among large employers (500 or more employees) grew from 18% in 2014 to 59% in 2016. Common selling points touted by telemedicine vendors include reduced health care costs and employee convenience. However, state licensure laws imposing restrictions on telemedicine […]

By | 2017-10-30T06:54:15+00:00 October 17th, 2017|2017 News, News|

DOL Opposes UnitedHealth’s Cross-Plan Offsetting Practice

“The Labor Department opposes a health insurance practice called ‘cross-plan offsetting,’ in which insurers like UnitedHealth reduce payments owed to medical providers for services rendered to specific patients. The reductions are meant to offset overpayments the providers previously received on account of different patients who participate in other plans insured by the same company. This […]

By | 2017-10-30T06:49:01+00:00 October 9th, 2017|2017 News, News|

Pregnancy is Not a Pre-existing Condition for Disability Insurance

The U.S. Court of Appeals for the Eleventh Circuit, in Bradshaw v. Reliance Standard Life Insurance Co., has rejected a disability insurer’s decision to deny disability benefits to an insured who suffered a stroke days after giving birth on the basis that her pregnancy was a pre-existing condition.

…While the Affordable Care Act has eliminated health […]

By | 2017-10-30T06:45:46+00:00 October 2nd, 2017|2017 News, News|

Well Drafted Plan Document Saves Self-Insured Medical Plan Over $350,000

“A self-insured medical plan included an anti-assignment provision that prohibited a health care provider from suing on behalf of a participant. The court found the anti-assignment clause to be valid and enforceable. This case highlights the value of a well drafted plan document. Employers sponsoring self-insured plans are encouraged to review their plan documents to […]

By | 2017-08-31T12:11:10+00:00 September 19th, 2017|2017 News, News|