Where we’re going

A study entitled, “Trends in the Concentration and Distribution of Health Care Expenditures in the US, 2001-2018” published in the JAMA Network Open[1] examined healthcare spending by between 30,461 and 39,165 individuals over that period. The authors[2] “sought to answer the following questions: How is the concentration of health care spending changing in the US … Continued

Having easy access to understandable information is critical to a quality healthcare system. It is so critical that since 1999, October has been designated as Health Literacy Month, a time to bring awareness to the importance of making complex health information easy for all to navigate. During Health Literacy Month, organizations and individuals raise awareness … Continued

On September 7, 2021, a massive group of Plaintiffs (all sponsors/administrators of, or self-insured group plans purchasing administrative services only (“ASO”) from the Defendants),[i] including Alaska Air, Albertsons Companies, American Electric Power, Boeing, Bridgestone, Burlington Northern, Conagra, Dollar General, FedEx, Kellogg, Kroger, Meijer, Publix, Walgreen, churches, benefit plans, and labor organizations filed an antitrust action … Continued

Under applicable federal law, all private insurance plans are required to cover the entire cost associated with approved COVID-19 testing provided the test is deemed medically appropriate. The U.S. government has also paid for COVID-19 vaccines with no out-of-pocket costs regardless of whether the vaccine recipient is insured or not. But there has been no … Continued

On January 1, 2021, the Federal Hospital Price Transparency Rule went into effect requiring hospitals to disclose certain pricing information. Specifically, the Rule requires hospitals to provide pricing information: in a “single machine-readable digital file containing the following standard charges for all items and services provided by the hospital: gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified … Continued

On August 20, 2021, the Health and Human Services, Labor and Treasury Departments released FAQs About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 49, which delays the enforcement of certain provisions contained in the No Surprises Act and the Transparency in Coverage (“TiC”) Final Rules. The reasons for the various delays include … Continued

We are halfway through the 2020 Olympic Games being held in Tokyo, Japan. As I write this, the United States is tied with China for the total number of medals won (46). We’ve witnessed new world records (Caeleb Dressel, Tatjana Schoenmaker, Emma Mckeon) and new sports (karate, surfing, climbing and skateboarding). You may be asking … Continued

On July 1, 2021, the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued the first set of regulations under the No Surprises Act – “Part I of the Requirements Related to Surprise Billing.”[1] Part I provides regulations for only a portion of the No Surprises … Continued

Over the past two years, we’ve followed and discussed the twists and turns in the Patient Protection and Affordable Care Act (the “PPACA”) legal battle.[1] In December 2020, we concluded that the Supreme Court would not overturn the PPACA. We anticipated that the Supreme Court may use the nullified penalty in the individual mandate as … Continued

In November 2017, ACS Primary Care Physicians Southwest PA and Emergency Services of Texas (affiliates of physician led TeamHealth), filed a lawsuit in Houston, Texas alleging that Molina Healthcare, Inc. and Molina Healthcare of Texas, Inc. failed to pay the usual and customary rates for out-of-network services.[1] ACS and Emergency Services of Texas sought more … Continued