Health Insurance Industry Issues and Legislation

Consumers avoided an estimated 10 million surprise bills due to the NSA just in the first 9 months of 2023. Unfortunately for payors and providers, more than half of the estimated 1 million claims remain unresolved. This even with 80% of claims being settled via negotiation between the parties. With providers are winning more far more of the cases than the government anticipated, the projection is that insurance premiums will rise, and consumer will end up the loser once again.

Smart payors are avoiding the entire time consuming, frustrating, and often costly NSA Independent Dispute Resolution process. They are having H.H.C. Group's skilled attorney case managers negotiate settlements for appropriate amounts. They are saving time, money and avoiding the hassle. 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.

The Supreme Court ruled that a precedent set in 1984 "Chevon" case requiring the courts to give deference to federal agencies is unworkable. In some cases, federal agencies have employed Chevron to justify decisions that enable health plans and insurers to control costs The ruling transfers the power to interpret and implement laws from the agencies to the judiciary. It could impact regulations affecting employers, patients, and consumers.

The U.S Food and Drug Administration (FDA) has approved 14 gene therapies, 9 since 2022. Up to 31 more may come to market this year and companies are actively recruiting for 600 gene therapy clinical trials. Efficacy and durability information for those on the market for at least 5 years is emerging, some good some not. How to pay for therapies costing up to $4 million is a major issue. For now, stop-loss carriers have found a way to pay but the government and private payors will need innovative strategies in the very near future.