Eric and Denise Kinsinger sued Eric’s employer, SmartCore, LLC, because its health plan failed to cover Denise’s hysterectomy despite preauthorization from the plan’s TPA. In addition to suing the corporation, the Kinsingers named plan administrators Steven Matthew Good and William H. Winn, Jr., personally as defendants for their roles as fiduciaries. On August 26, 2019, [...]
On July 17, 2019, the IRS, in conjunction with the Treasury Department, issued Notice 2019-45. This notice expands the list of preventive care items and services permitted to be covered by a high deductible health plan (HDHP) before the deductible is satisfied, without jeopardizing the covered person’s ability to make or receive contributions to a [...]
On June 13, 2019, the Departments of Health and Human Services, Labor and Treasury released final regulations that will expand the use of Health Reimbursement Arrangements (HRAs), starting in January of 2020. The regulations will allow the integration of HRAs with individual health insurance coverage and also allow certain HRAs to be recognized as “excepted [...]
On Monday, President Donald Trump signed an executive order that may shake up the entire system of healthcare. The goal of the order is to increase transparency in order to help reduce costs and improve the quality of care. Under the order, patients will gain access to pricing information that is currently not available. Providers [...]
A bipartisan bill called the Lower Health Care Costs Act is under discussion in the Senate Health committee. It addresses surprise medical bills, high drug prices, and public health problems. It would also improve transparency to ensure that pharmacy benefit managers pass along drug discounts to customers. In addition, the bill aims to prevent certain [...]
Lawmakers on both sides of the aisle are applauding two recent developments in the ever-raging battle to contain the cost of American healthcare. On May 8, 2019, the Department of Health and Human Services (HHS) announced a final rule from the Centers for Medicare & Medicaid Services (CMS) that will soon begin requiring pharmaceutical manufacturers [...]
Telehealth, a form of “virtual healthcare” where diagnosis and treatment are delivered remotely through the use of technology (typically via telephone or video chat), is becoming an increasingly popular element of the US healthcare landscape. Employers and insurers are attracted to telehealth by its relatively low cost as compared to traditional healthcare. For patients, online [...]
AHPs were created in 2017 by President Donald J. Trump’s Executive Order, and the Department of Labor (DOL) expanded on them in 2018. The goal was to promote healthcare choice and competition across the United States. The changes allowed unrelated small businesses to join together to get better underwriting and avoid certain mandates. However, a [...]
Should hospitals and other healthcare providers publicly disclose the secretly negotiated prices they charge insurance companies for their services? Today’s complex arrangements, hidden charges, and lack of transparency make it hard to tell which hospitals and doctors are driving costs higher. Insurers and hospitals routinely enter into confidentiality agreements that make it possible for the [...]
The Affordable Care Act (“ACA”) requires larger employers (50 or more full-time equivalents) to offer “affordable” “minimum-value” health care to employees working 30 or more hours per week or face the possibility of significant penalties. In response, some employers cut employee hours to avoid offering health insurance. The recent class action settlement proposed by Dave [...]