Is the Legislative Focus on Surprise Billing Misplaced?

In a September 3, 2019 article in Health Affairs, Michael E. Chernew, Maximillian J. Pany, and Richard G. Frank make the argument for market-based price caps to address soaring health costs. “The gap between prices in the US and other countries, the large price-cost margins in the commercial sector, and the wide variation in prices … Continued

KFF Annual Employer Health Benefits Survey

Today the Kaiser Family Foundation released its annual Employer Health Benefits Survey. The annual survey of employers “provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. The 2019 survey included 2,012 interviews with nonfederal public and private firms.” Here are just … Continued

Surprise Medical Bills Study

On June 20, 2019, Peterson-Kaiser published “An examination of surprise medical bills and proposals to protect consumers from them.” The study used “claims data from large employer plans to estimate the incidence of out-of-network charges associated with hospital stays and emergency visits that could result in a surprise bill.” It also surveyed state and federal … Continued

Ground Ambulances and Surprise Billing Legislation

Ground ambulance bills are the largest source of unexpected out-of-network medical bills according to research by Christopher Garmon, a health economist at the University of Missouri-Kansas City. His research showed that “[i]n more than half of cases involving ambulance transportation, the ambulance services were out of network […].”[1] Over 50% of ground ambulance rides end … Continued

The Current State of Federal Surprise Medical Billing Legislation

As the statistics demonstrate, surprise medical billing is a big issue in the U.S.: About 1 in 6 Americans are faced with a surprise medical bill each year. 16% of inpatient stays and 18% of emergency visits leave patients with out-of-network charges. 26% of admissions from the emergency room result in a surprise medical bill.[1] … Continued

Senator Cassidy Sits Down With aequum

aequum recently had the opportunity to speak with Dr. Bill Cassidy, a Senator from Louisiana, about his thoughts on the current health care situation in the U.S. Senator Cassidy attended Louisiana State University School of Medicine where he earned an M.D. He specialized in the treatment of diseases of the liver at the Earl K. … Continued

Cross-Plan Offsetting in the Cross Hairs of ERISA

A recent decision from the U.S. Eighth Circuit Court of Appeals in Peterson v. UnitedHealth Group, Inc., et al., No. 17-1744 (8th Cir. 2019), and the lower court decision it affirms, place the practice of cross-plan offsetting squarely in the cross hairs of ERISA. Cross-plan offsetting is the recovery of alleged overpayments to a specific … Continued

Barriers to RBP Plans

“Few employers are using reference-based pricing (RBP) benefit design, even though there is broad awareness of its potential for delivering savings,” according to a qualitative study published in the February issue of The American Journal of Managed Care®. “Evaluations of US RBP programs have found reduced spending between 13.9% and 31.0% for joint replacement surgery, … Continued


Presently, Medicare pays only for emergency ground ambulance services when patients are transported to hospitals, critical access hospitals, skilled nursing facilities, and dialysis centers. Most Medicare beneficiaries are thus transported to one of these facilities even when a lower-acuity destination may be more appropriate. Based upon a White Paper by the U.S. Departments of Health … Continued