You Can’t Shop for Something if You Don’t Know the Cost

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 [...]

By |2019-03-21T09:08:59+00:00March 21st, 2019|2019 News, News|

Dave & Buster’s Busted

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 [...]

By |2019-02-27T11:25:38+00:00February 27th, 2019|2019 News, News|

Employers Encouraged To Review Health Plan Administrators’ Payment Practices After Recent Court Decision

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 [...]

By |2019-01-28T13:40:02+00:00January 28th, 2019|2019 News, News|

Don’t Lament, “I Could Have Done More”

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 [...]

By |2019-01-02T09:16:13+00:00January 1st, 2019|2019 News, News|

Court Rules ACA Unconstitutional – But Law Remains in Effect for Now

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 [...]

By |2019-01-02T08:55:44+00:00January 1st, 2019|2019 News, News|