March 2020 •
Volume 3 •
Issue 13
Providing Current Information on
Health Insurance Industry Issues and Legislation
The Surprise Billing Battle Rages On
The battle over surprise billing legislation continues on in Congress with no sign of
letting up. On one side are hospitals and their doctors, many owned by private equity
backed companies. On the other its healthcare insurers, who once again just reported
record profits. Both are employing television and the internet and pouring millions
into furious lobbying. Doctors, with their professional credentials, appear have an
advantage versus the insurance companies' hired guns. All sides are funneling millions
to lawmakers, Republicans and Democrats alike. All want the bill passed that will mean
the most money in own their pockets.
letting up. On one side are hospitals and their doctors, many owned by private equity
backed companies. On the other its healthcare insurers, who once again just reported
record profits. Both are employing television and the internet and pouring millions
into furious lobbying. Doctors, with their professional credentials, appear have an
advantage versus the insurance companies' hired guns. All sides are funneling millions
to lawmakers, Republicans and Democrats alike. All want the bill passed that will mean
the most money in own their pockets.
What to Do While the Battle Rages On
Nobody knows how long the surprise billing fight will continue and when, or
even if, any surprise billing legislation will finally be enacted. Until the federal
government or the states pass surprise billing legislation, those costly surprise bills
from out-of-network providers for emergency room visits and hospital admissions
and other services will continue to be a costly thorn in insurers' side. But they
don't have to be. Utilizing a combination of technology and tenacity, a skilled cost
containment company, like HHC Group, is finding a ways to cut surprise and other
out-of-network bills down to size.
even if, any surprise billing legislation will finally be enacted. Until the federal
government or the states pass surprise billing legislation, those costly surprise bills
from out-of-network providers for emergency room visits and hospital admissions
and other services will continue to be a costly thorn in insurers' side. But they
don't have to be. Utilizing a combination of technology and tenacity, a skilled cost
containment company, like HHC Group, is finding a ways to cut surprise and other
out-of-network bills down to size.
Specialty Medication Costs Continue to Soar
The specialty drug trend is projected to increase by 15% in 2020. As result, specialty drugs
could account for 50% of total U.S. drug spend this year. With an ever increasing number
of new medications in the pipeline and the introduction of gene therapies, it is more
important than ever to develop strategies to help control utilization and spending for
high-cost medications. Employing best practices starting with plan designs that address
prior authorization for higher cost drugs, exclusion of non-essential drugs, step therapy
etc. are key. So, too, are setting up prior authorization criteria, rules for exploring other
medications in the same class and much more.
could account for 50% of total U.S. drug spend this year. With an ever increasing number
of new medications in the pipeline and the introduction of gene therapies, it is more
important than ever to develop strategies to help control utilization and spending for
high-cost medications. Employing best practices starting with plan designs that address
prior authorization for higher cost drugs, exclusion of non-essential drugs, step therapy
etc. are key. So, too, are setting up prior authorization criteria, rules for exploring other
medications in the same class and much more.
Rural Hospitals on the Rocks
Rural and critical access hospitals are closing at an alarming rate. A record 19 closed
their doors last alone. 120 rural facilities shuttered their door in the last decade.
According to a report from the American Hospital Association, these hospitals are
typically cash strapped and have to deal with labor shortages, high drug prices and
inadequate payment from government programs. The report lays out the operational
and financial warning signs signaling that a rural hospital is on the path to closure.
their doors last alone. 120 rural facilities shuttered their door in the last decade.
According to a report from the American Hospital Association, these hospitals are
typically cash strapped and have to deal with labor shortages, high drug prices and
inadequate payment from government programs. The report lays out the operational
and financial warning signs signaling that a rural hospital is on the path to closure.
Three Star Preferred Provider Program Additions
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Roseville, MN 55113 Nourishing Wellness Med Redondo Beach, CA 90277 |
Pomona, CA 91767 LabCorp Indiana South Bend, IN 46601 |
