Health Insurance Industry Issues and Legislation

Managing high-cost out-of-network claims can be challenging, but H.H.C. Group's expert negotiation team rises to the occasion every time.

This Month's Highlight:

A Northern California ambulatory surgery center billed $839,565.55 for a laparoscopic procedure and assistant surgeon fees. Leveraging CMS guidelines, proprietary databases, and extensive experience, H.H.C. Group's case manager negotiated the charges down to $120,000.

The Result:

• Total Charges: $839,565.55
• Negotiated Amount: $120,000
• Client Savings: $719,565.55 (85.7%)
• Procedure Charge Savings: 91.7% reduction
• Assistant Surgeon Charge Savings: 81.1% reduction

H.H.C. Group announces its Complimentary Claim Review Program, providing payors the opportunity to experience the benefits of its industry-leading services risk-free. This initiative is designed to empower payors with a proven approach to better manage in- and out-of-network high-cost medical claims and workers' compensation bills to maximize savings in the year ahead.

H.H.C. Group proudly announces that it successfully completed its latest URAC Monitoring Validation Review as an Independent Review Organization (IRO). H.H.C. has been a URAC accredited IRO since 2004. By achieving this status, H.H.C. has demonstrated its commitment to quality care, enhanced processes, patient safety and improved outcomes.

H.H.C. Group is pleased to welcome Lou Fiscella as Vice President of Sales. Fiscella brings over 20 years of experience in healthcare sales, strategy and client relationship management, most recently serving in leadership roles at CVS Health/Aetna.

A New Jersey federal court is handling lawsuits alleging insulin manufacturers and PBMs colluded to inflate prices, impacting employers and state health plans. Discovery may uncover critical pricing practices, shaping potential class-action suits.

Telehealth usage in the U.S. increased by 2% overall from September to October 2024, with the West showing the largest regional growth at 2.8%, according to FAIR Health's Monthly Telehealth Regional Tracker. However, the Midwest saw a 3.7% decline in telehealth claims, making it the only region to experience a decrease. Mental health remained the most common telehealth diagnosis nationwide, followed by acute respiratory diseases, infections, and developmental disorders.