Lawsuits from non-network providers have been on the rise recently due to the sharp rise in their billing rates, more providers moving out-of-network, and self-insured health plans reducing reimbursement rates. One of the ways that health plans have curtailed out-of-network reimbursement rates is through reasonable and customary reductions. A health plan is required to disclose the […]
According to a 2013 study published in JAMA in March, people with Medicare Part D drug insurance unknowingly overpaid for prescriptions by $135 million. Copays in those plans were higher than the cash price for nearly 25% of drugs purchased. Patients overpaid by more than 33% for 12 of the 20 most commonly prescribed drugs.
Concern over surprise medical bills—those from out-of-network physicians that patients had no role in choosing—has grown tremendously in recent years. Some states have taken steps to mitigate this problem. However, these measures do not apply to the roughly half of Americans enrolled in self-insured health plans because ERISA precludes states from regulating these plans.
A bipartisan group […]
The term telehealth encompasses clinical diagnosis, education, management, and the monitoring of health via technology. It is not a specific service, but rather an umbrella term for a variety of strategies to enhance medical care delivery.
The greatest advantage of telehealth is ease of access. Patients can quickly and easily speak with doctors making them more likely to […]
The IRS answers FAQs regarding The Affordable Care Act’s employer shared responsibility provisions related to:
- Basics of the Employer Shared Responsibility Provisions
- Employers Subject to the Employer Shared Responsibility Provisions
- Identification of Full-Time Employees
- Offers of Coverage
- Affordability and Minimum Value
- Liability for the Employer Shared Responsibility Payment
- Calculation of the Employer Shared Responsibility […]
Last year the EEOC sued cosmetics and fragrance giant Estée Lauder, claiming its parental leave policies discriminated against men. Estée Lauder provided eligible new mothers with six weeks of paid parental leave for child bonding (in addition to leave for recovery for childbirth), but it only offered new fathers two weeks of paid bonding leave. Estée […]
Promises from drug makers to control persistent increases in drug costs seem to last only as long as it is politically expedient to make them. To counteract this behavior, the Trump administration has floated proposals such as promoting competition from generic drugs and changing Medicare drug-purchase policies. Some experts are not ruling out new regulations […]
The number of patients with claims in self-funded plans from $1 million to $1.5 million rose from 104 in 2014 to 194 in 2017 according to a new Sun Life Financial report. Over the four year period, high claims totaled $6.9 billion. Cancer represented $798.7 million, followed by metabolic disorder and hemophiliac disorder.
The Medical Association of Georgia (MAG) and the American College of Emergency Physicians have sued Blue Cross Blue shield of Georgia (BCBSGA) over Anthem’s policy of denying payment for emergency department visits that are later deemed non-emergent. The plaintiffs allege that the policy violates the ACA, which requires insurers to cover emergency care based on a […]
“Many [plan sponsors] are purchasing cyber liability insurance coverage to supplement their data security measures…. [M]any policies vest the decision to retain legal counsel in the insurer, rather than the policyholder…. Plan sponsors should also identify the plan’s service providers who have access to PII and PHI and ensure that the plan’s cyber liability policy […]