Where we’re going

In a recent ruling, the Fifth Circuit Court supported important aspects of the No Surprises Act (NSA), reinforcing provider protections and clarifying how insurers should determine the Qualified Payment Amount (QPA). This decision not only influences the structure of out-of-network billing disputes but also aims to ensure more transparency and timely payments. Here’s a look … Continued

With the rapid modifications in healthcare legislation, it is essential for plan sponsors and employers to stay informed. Christine Cooper and Jack Towarnicky’s recent BenefitsPRO article provides a comprehensive analysis of how this landmark legislation could reshape the dynamics of employer-sponsored health plans. Understanding the Inflation Reduction Act (IRA) The Inflation Reduction Act (IRA) introduces … Continued

The Hospital Price Transparency Rule mandates that hospitals publicly disclose comprehensive pricing data, including negotiated rates for all services and items. The 2024 Hospital Price Transparency Report paints a concerning picture of noncompliance with federal hospital price transparency rules. Of the 2,000 hospitals reviewed, only 21.1% were found to be fully compliant. The report underscores … Continued

The Kaiser Family Foundation’s (KFF) 2024 Employer Health Benefits Survey offers a comprehensive snapshot of the current state of employer-sponsored healthcare in the U.S. Covering over 154 million nonelderly Americans, employer-sponsored plans are a cornerstone of healthcare delivery. The survey highlights trends such as rising premiums, shifting plan designs and the increasing prevalence of high-deductible … Continued

In this recent Benefits Law Journal article, Jack Towarnicky, aequum member, identifies a number of the statutory requirements designed to improve health care claims processing – changes that were included in Health Reform and subsequent laws. Jack asserts that health reform mandates and bureaucratic solutions may not be the most cost-effective option to achieve the … Continued