Where we’re going

The No Surprises Act (NSA) was intended to protect patients from surprise medical bills and keep them out of payment disputes between providers and health plans. By many accounts, that objective has been achieved. During a recent industry webinar, provider-side attorney James Greenspan stated that “the overarching goal of the law seems to have been … Continued

Healthcare brokers have always played an important role in helping employers manage rising healthcare costs. Today, that role is expanding as benefit brokers become strategic partners. As reimbursement disputes become more complex and high-cost out-of-network claims continue to challenge plan performance, brokers are increasingly expected to deliver strategies that can withstand real-world pressure. Many are … Continued

Healthcare costs are rising – but for many self-insured employers, the bigger challenge is unpredictability. Traditional network pricing often leaves plans reacting to costs rather than managing them. As provider reimbursement pressures grow and cost shifting accelerates, the No Surprises Act (NSA) continues to drive volatility across the healthcare landscape. Those realities were at the … Continued

A growing number of plan sponsors are starting to feel a new type of pressure  – and it’s not just from rising health care costs. There is a realization that others may be gaining a competitive advantage they don’t yet have, introducing a sense of FOMO (Fear Of Missing Out) that is starting to influence … Continued

The relationship between health plans and providers is one of the most important and most complex dynamics in healthcare. It directly shapes cost, experience and long-term plan performance. Yet for many self-insured plans, that relationship is not actively managed. It is experienced after the fact, through claims, billing disputes and unexpected costs. aequum approaches provider … Continued

When the No Surprises Act (NSA) took effect, it was widely viewed as a major step forward in protecting patients from unexpected medical bills and curbing excessive out-of-network pricing. It created clear standards around balance billing, established payment frameworks and introduced the federal Independent Dispute Resolution (IDR) process to help resolve payment disagreements between plans … Continued

The No Surprises Act (NSA) was designed to reduce unexpected medical bills and create a fair process for resolving out-of-network payment disputes. Central to that framework is the Independent Dispute Resolution (IDR) process, intended to bring balance between providers and payers. What it did not anticipate was how that process could be used at scale … Continued

Self-insured health plans are under pressure from every direction. Medical inflation is rising, high-cost therapies are becoming more common and provider charges remain opaque and inconsistent. Employers that sponsor these plans face a growing challenge, how to protect their health plan’s assets without compromising care or compliance. That’s where aequum comes in. aequum doesn’t just … Continued

The No Surprises Act (NSA) was designed to protect plan members from some but not all unexpected medical bills. What the NSA did not do was protect employer-sponsored plans from escalating disputes over covered charges, procedural abuse and rising Independent Dispute Resolution (IDR) costs. Providers regularly claimed more than what the NSA allowed participants to … Continued

The Independent Dispute Resolution report covering 2024 from the Congressional Research Service echoes what plan sponsors have sensed for months. A process that was supposed to bring order to out of network payment disputes is now crowded, driven by provider actions and far less predictable. For self-insured employers, the takeaway is straightforward: Do not expect … Continued