Where we’re going

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

The connection between health and wealth has never been more obvious or more dangerous. According to the Consumer Financial Protection Bureau (CFPB), over 15 million Americans currently have medical debt over $500 that’s more than a year old. That debt doesn’t just sit on a spreadsheet. It destroys credit, drains savings, limits access to loans … Continued

As we enter a new year, self-insured employers are taking stock of what they’ve faced, what they’ve learned and what lies ahead. At this past Self-Insurance Institute of America National Conference, the conversation wasn’t just about what’s happening now, it was about what’s coming next. From artificial intelligence to fiduciary litigation, the sessions and sidebars … Continued

Why IDR Awards Still Don’t Guarantee Payment and What Plan Sponsors Should Take Away A recent decision from the U.S. District Court for the District of New Jersey reinforces a message plan sponsors have been hearing with increasing frequency: the No Surprises Act (NSA) created a payment framework without a reliable enforcement mechanism. The aequum … Continued

The relationship between self-insured health plans and third-party administrators (TPAs) is under more scrutiny than ever. As courts raise the bar on fiduciary oversight and regulators close enforcement gaps, employers must work closely with their TPA to ensure compliance. aequum believes that real protection begins with full transparency and understanding. That’s why we work closely … Continued

A new lawsuit filed by UnitedHealthcare (UHC) against Radiology Partners, the largest radiology group in the U.S., exposes the growing tension between payers and providers under the No Surprises Act (NSA). Beneath the headlines, there’s a message every plan sponsor needs to hear: regulatory protections won’t stop aggressive billing tactics unless your plan is structured … Continued

The latest analysis from QBE confirms what many plan sponsors already suspect, catastrophic claims are becoming more frequent, more severe and more expensive to insure. In less than five years, the frequency of million-dollar stop loss claims has doubled. Cancer remains the top cost driver, and specialty drug therapies are pushing claims even higher. For … Continued

The recent decision in Tiara Yachts v. Blue Cross Blue Shield of Michigan highlights a growing legal threat facing employers that sponsor self-insured health plans. It sends a clear message to plan sponsors that they cannot assume their administrator is always acting in the best interest of the plan. More importantly, they cannot afford not … Continued