Health Insurance Industry Issues and Legislation

Providers and patients are the big winners and payors the big losers in the implementation of the No Surprises according to the Brookings Institute. Based on emergency room, imaging, neonatal, and pediatric critical care cases providers were the winners in more than 75% of the cases. Across these categories the median payout was 3.7 times the Medicare rate. For emergency room care and imaging the median decision was more than 50% higher than the most generous commercial plan levels.

Smart payors are avoiding the entire time consuming and, majority of the time, costly NSA Independent Dispute Resolution process. They are having H.H.C. Group's skilled attorney case managers negotiate with the provider and secure signed agreements as soon as the provider send their bill. They are saving time, money and avoiding the hassle of the whole dispute resolution process. Click here to have H.H.C. Group start saving you time and money on your surprise bill, out-of-network, and in-network claims?

Congress is seeking input on potential changes to ERISA. Payors and providers offered vastly different on ideas on where Congress should focus its efforts. Employer plan sponsors are pushing for stronger preemption over state law requirements while providers. Providers want Congress to address the potential for "harmful self – dealing" by large insurers servicing as third-party administrators for self-funded plans.

2024 will be a year in which self-funded plans and their administrators will need to adapt and innovate in the ever-shifting healthcare landscape. Innovative plans will be integrating AI and predictive analytics, leveraging the increasing use of telehealth virtual care, and considering how to use technologies like wearable devices to track patient activity, and identify potential health risks proactively and improve plan member involvement and satisfaction.