Health Insurance Industry Issues and Legislation

In 2023 the percentage of employers with 500 or more employees self-funding for healthcare increased from 72% - 74%. Conversely, the percentage of employers with 100 – 500 employees plummeted from 37% to 32% while those with less than 100 employees dropped from 18% to 16%. A probable cause in the declines for smaller employers may be numerous states imposing regulations and laws discouraging the sale of low attachment point stop-loss products.

Over 123 million people in the US have obesity.. The condition is linked to 200 medical conditions. GLP-1s reduce the odds of heart attacks, stroke, or cardiac death and virtually eliminate the risk of developing type 2 diabetes. So, does covering GLP-1s in plans make financial sense? On one side of the equation is what members with obesity now cost group annually. On the other is the cost of the drugs and reduction in claims costs and the reductions in absenteeism and disabilities.

A-1 and automated systems are good for identifying some claim errors. HHC Group's skilled negotiators, Medical Director and clinical staff go much further to determine the appropriate amount our clients should pay on their in and out-of-network claims. Recently, on a $2.3M claim with a 20% PPO discount, that amount was $531K. Our negotiator then found the decision maker and got them to agree to accept that amount as payment in full, something no automated system could do, saving our client an additional $1.3M.

A J.D. Power consumer survey found moderate levels of satisfaction and that many issues remail. Convenience and speed with the primary reasons for using Telehealth. I in 4 found internet and cellphone connectivity posed the greatest barrier to using telehealth and the same number found that the limited services offered were a major challenge. Finally, fewer than half of those with chronic conditions using telehealth for follow-up visits had a positive experience.