Is There Value in a Reference Based Pricing Strategy? YES! Is There an ERISA Fiduciary Duty to Offer? NO!

Reference Based Pricing Provides Great Value, Without ERISA Fiduciary Risk Exposures A recent BenefitsPro article argues that given the federal government’s endorsement of Reference Based Pricing (RBP) and its proven efficacy in reducing employer costs and expanding participant options, it is now virtually impossible for a plan fiduciary to lawfully discharge their duties in accordance with ERISA … Continued

Federal Reserve Report: Economic Well-Being of Households in 2022

A Federal Reserve report released in May evaluated the results from the 2022 Survey of Household Economics and Decisionmaking (SHED). Generally, the report found a decline in peoples’ financial well-being over 2021 and the self-reported financial well-being was among the lowest observed since 2016. With respect to health care expenses, the report found that many … Continued

May is Mental Health Awareness Month

May is Mental Health Awareness Month.  It has been observed since 1949. This year the National Alliance on Mental Illness is celebrating with the More Than Enough campaign: It’s an opportunity for all of us to come together and remember the inherent value we each hold – no matter our diagnosis, appearance, socioeconomic status, background … Continued

‘No Surprises Act’ Website Captures Industry and Litigation Updates, Advances Understanding and Compliance

More than a year ago, the U.S. healthcare system marked a turning point with the passage of  federal legislation that went into law intending to protect Americans from unexpected provider charges, a once common practice known as “balance billing.” Taking effect January 1, 2022, the No Surprises Act (NSA) covers patients and participants in employer-sponsored health … Continued

Reprise: Surprise Does Not Equal Unexpected When It Comes to Medical Bills

Just as Americans were starting to express a sigh of relief following an assumed end to medical balance billing under the provisions of the No Surprises Act, many health plan participants are experiencing the difference between “surprise” and “unexpected.” According to a survey conducted by Morning Consult, many respondents claim to have received surprise medical bills since the No … Continued

Self-Insurance: The Impact of Health Reform

Health Reform accelerated the trend to self-insure health plans, large and small. The Department of Labor’s annual reports have not identified any negative impact on participant benefits or the public marketplace exchanges. Plan sponsors of self-insured plans should ensure that plan document provisions authorizing the use of discretion by the plan administrator are in sync … Continued

A Year in Retrospect: How the No Surprises Act Impacted Medical Billing

The Best Response to the NSA is Still a Strategic and Compliant Approach One year ago, the United States marked a turning point for health care cost transparency with a new law aimed at helping Americans avoid unnecessary, unexpected medical debt. The No Surprises Act (NSA) was signed into federal law after years of negotiation between health … Continued

Post-Pandemic Era Poses Challenges and Opportunities for Employer Sponsored, Self-Insured Health Plans

Providing employees with access to affordable, quality healthcare is one of the greatest economic challenges for employers today. Finding the right balance between a benefit package that is both adequate and affordable — yet financially sustainable — has never been easy. Now, these efforts are compounded by COVID-19 and its significant post-pandemic challenges.    While Plan … Continued

Credit Reporting of Medical Debt: An Update

In March 2022, the Consumer Financial Protection Bureau (“CFPB”) issued a 54 page report regarding the impacts of medical debt on consumers. The CFPB research showed that $88 billion in medical debt was on consumer credit records as of June 2021 and most medical debt collection tradelines[1] are under $500. In response, Equifax, Experian, and … Continued