ERISAPros News

Trump Orders New Requirements for Upfront Hospital Cost Disclosure

By |June 26th, 2019|

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 [...]

The Camel’s Body is In the Tent

By |June 12th, 2019|

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 [...]

Telehealth – The New Frontier of US Healthcare

By |April 15th, 2019|

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 [...]

Association Health Plan (AHP) Provisions Ruled Illegal

By |April 4th, 2019|

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 [...]

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

By |March 21st, 2019|

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 [...]

Dave & Buster’s Busted

By |February 27th, 2019|

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 [...]

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

By |January 28th, 2019|

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 [...]

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

By |January 1st, 2019|

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 [...]

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

By |January 1st, 2019|

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) [...]

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