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 [...]

In Peterson v. UnitedHealth Group Inc., plaintiffs filed a class action lawsuit against United Healthcare claiming that its cross-plan offsetting practice violated ERISA.  This practice allows an insurer or third party administrator (TPA) to recover overpayments to a provider by offsetting future payments for claims related to different employers’ plans and participants. The claims can [...]

Employers are often surprised to learn they are liable for ERISA statutory penalties associated with participant document requests even though they have retained an insurance company or TPA to administer their ERISA welfare benefits plans. Generally, only the Plan Administrator, as defined by ERISA, can be penalized for failure to respond to document requests, and, almost [...]

In 2017 Congress enacted the Tax Cuts and Jobs Act, which reduced the individual mandate penalty to zero, effective January 1, 2019. Recently a federal district court in Texas ruled that the Affordable Care Act’s individual mandate is no longer permissible under Congress’s taxing power and that the entire Affordable Care Act (ACA) is invalid because the individual [...]

The IRS has released the 2019 inflation-adjusted limits for certain welfare benefit plans and the amounts used for discrimination testing. The salary reduction limitation for health flexible spending account coverage for 2019 is $2,700, an increase of $50 over the amount for 2018. The 2019 health savings account ("HSA") limit will increase to $3,500 for [...]

The ACA requires large employers to report the total cost of employer-sponsored group health coverage on employees’ W-2s, which are due to employees by January 31, 2019. Reporting the cost of health care coverage on the Form W-2 does not mean that the coverage is taxable. It is for informational purposes only and will provide employees useful [...]

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 [...]