Health Insurance Industry Issues and Legislation

Thousands of investors and executives from health care companies, and tech innovators gather at J. P. Morgan' annual HealthCare Conference. Presentations by pharma, bio tech and healthcare companies spotlight key areas of innovation. Major topics this year ranged from the impact of everything from AI to new treatments for auto immune diseases that will have the greatest impact on healthcare treatments and healthcare costs in the coming year.

The projected 7% increase in healthcare costs this year makes saving every dollar spent on healthcare claims more important than ever. That's why every day HHC Group fights to save its clients as much as possible on every out-of-network claim, no matter how big or small. With experienced attorney negotiators, advanced technology, PPO network partners including MultiPlan, and nurse driven medical bill reviews, we're delivering the savings our clients need to in their fight against healthcare cost inflation.

Lawsuits against TPAs of companies self-funding for healthcare and insurers may refine fiduciary responsibilities and the role of TPAs in plan administration. One, filed by the Department of Labor, alleges a service of violations pertaining to the Employment Retirement Income Security Act of 1974 (ERISA). Others reflect growing scrutiny of TPAs and other stakeholders regarding claims payment, oversight, and access to medical records.

It's estimated that the No Surprises Act has prevented more than 10 million patients from receiving unexpected bills. That's good. What's not good is that more than 400,000 claims submitted for resolution are still unresolved. Providers claim the rules are stacked against them, payment is delayed by 6 months or more, and insurers aren't paying after decisions have made. Payors say providers are using the process to inflate their profits.