Federal Court Rules Against Association of Air Medical Services: A Win for Patients and Payers and a Huge Loss for Air Ambulance Companies

The federal government prevailed at summary judgment in a case brought by the Association of Air Medical Services (the “Association”) against the U.S. Department of Health and Human Services et al. (“HHS”), marking it the government’s first major victory in the string of court challenges to the No Surprises Act (the “NSA”). No Surprises Act … Continued

Survey Reveals Provider Frustrations Over No Surprises Act, Alleges Payers Ignore Independent Dispute Resolution Rulings

While the No Surprises Act (NSA) intends to end surprise medical billing, also known as balance billing, and protect patients from receiving high out-of-network charges in certain situations, there remain challenges with enforcement over rulings made through the Independent Dispute Resolution (IDR) process. A new survey conducted by the Americans for Fair Health Care (AFHC) … Continued

Texas Medical Association Case Rulings: One Prompted HHS to Reduce Fees for Independent Dispute Resolution, A Second Rejects Regulations That Defined the Qualified Payment Amount

Compliance with the No Surprises Act (NSA) remains a priority for employer-sponsored health plans The NSA ends surprise medical billing, also known as balance billing, in certain situations – such as emergency care or services from out-of-network providers at in-network facilities. Physicians and other payers continue to challenge agency regulations implementing NSA, specifically provisions that … Continued

Price Transparency Has Limited Value if Not “Done Right”

Advance Transparency in Coverage (TiC) rules require employers to provide employees with easy access to an online shopping tool featuring 500 shoppable services and highlighting personalized out-of-pocket cost information for covered healthcare items and services. These pivotal transparency mandates are intended to spearhead a massive shift in the role of the patient as a healthcare … Continued

HHS’s First Annual Report Evaluating the Impact of the No Surprises Act

The Departments of Health and Human Services (HHS) issued the first annual report on the impact of the No Surprises Act (NSA). The report “focuses largely on establishing a baseline and a framework for further evaluation” and “details key trends in factors that will be important to evaluate NSA effects including: the implementation and impacts … Continued

aequum CEO Christine Cooper Wins TITAN Woman in Business Award

The TITAN Women In Business Awards annually celebrates the achievements of women who are making a significant contribution in various industries and professions, from accomplished executives to rising entrepreneurs, who demonstrate exceptional innovation, excellence, and leadership in their respective fields. Through its partnership with the International Awards Associate (IAA), this esteemed competition has captured the … Continued

Perspective on Specialty Rx and Alternative Funding Programs

Prescription drug costs are a major concern among employer groups of all sizes. Increased use of prescription drugs increased nationwide spending tenfold – from $30 billion in 1980 to $335 billion in 2018 (adjusted for inflation in 2018 dollars). Driving much of that increase over the past ten years is specialty pharmacy whose costs have … Continued

Declaring a National Crisis, Providing Affordable Mental and Behavioral Support Remains a Priority for Employer Sponsored Health Plans

As our nation continues to experience a surge in post-pandemic demand for behavioral health counseling and therapy over residual stress, anxiety and depression, Americans are finding it difficult to access and afford mental and behavioral health services. In fact, President Biden declared a National Behavioral Health Crisis during his 2022 State of the Union address, … Continued

Healthcare Inflation Unusually Trails General Inflation, Squeezing Financially Fragile Employees from Both Sides

Many are questioning how the U.S. healthcare inflation rate compares to the rest of our nation’s economy. The simple answer: it’s significantly lower, which is unusual given that healthcare inflation historically outpaces general inflation. According to McKinsey, inflation is at record highs. Consumer prices have rarely risen faster than healthcare inflation, but that’s the situation … Continued

Annual Enrollment Should Start Now with a Proactive Strategy

The indexed Health Savings Account (HSA) and Health Reimbursement Arrangements (HRA) numbers are out –”triggering” the start of  2024 annual enrollment discussions and planning! It is time for employers with a calendar year plan year to begin to “proactively” prepare for annual enrollment.   As reported by SHRM, annual HSA contribution limits for 2024 are … Continued