Where we’re going

At this year’s Disability Management Employer Coalition (DMEC) Compliance Conference in Columbus, Ohio, aequum’s Jack Towarnicky offered insight on two mental health topics: Mental Health in the Workplace and The Mental Health LTD Challenge: Because Parity is Not a Priority … Yet. These conversations confirmed that employers, plan sponsors and disability management administrators can no … Continued

I read with interest Ben Dobler’s February 5, 2025, article on “Why Health Savings Accounts (HSAs) Aren’t Always Worth the ‘Triple Tax Savings’[i]. Ben notes that HSAs require individuals to be covered by a “High Deductible Health Plan” which has tradeoffs compared to traditional coverage. However, my 20+ years of hands-on experience with HSA-capable coverage … Continued

The No Surprises Act (NSA) was created to protect patients from a number of surprise medical bills — such as for emergency treatment by out-of-network providers at in-network facilities. However, recent layoffs at the federal agency responsible for enforcement may have put those protections at risk. With fewer regulators and mounting dispute volume, oversight is … Continued

The Consumer Financial Protection Bureau (CFPB) has taken bold steps to curb the impact of medical debt on consumers, including efforts to eliminate medical debt from credit reports and crack down on abusive billing practices. As the political landscape shifts, the future of these protections grows increasingly uncertain. This change creates risk for self-insured health … Continued

A high-profile lawsuit involving JPMorgan Chase is putting employers on alert that managing a self-insured health plan now comes with serious legal risk. Even responsible companies can be sued if they’re not actively controlling healthcare costs. In this case, JPMorgan employees claim the company mismanaged its prescription drug benefits by selecting a pharmacy benefit manager … Continued

Health insurance claim denials are on the rise, creating new challenges for patients, employers and plan sponsors. Behind many of these denials are layers of administrative complexity—such as prior authorization requirements, coding errors and insurers’ cost-cutting tactics that often block or delay payment for legitimate medical services. In 2023, nearly 20% of claims submitted to … Continued

The latest Healthcare Price Transparency Executive Order reaffirms the federal government’s commitment to ensuring that hospitals and insurers disclose actual healthcare costs rather than vague estimates. This action aims to empower patients and create a more competitive market for consumers using health care services. However, plan sponsors and providers may garner greater value from those … Continued

The role of private equity (PE) in healthcare has expanded rapidly, reshaping financial and operational priorities. From large hospital systems to specialized physician groups and ancillary services, PE firms have been acquiring healthcare organizations at an unprecedented rate. The repercussions from such investments are complex, potentially increasing healthcare costs, reducing the quality of care and … Continued

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