Health Insurance Industry Issues and Legislation

Hospital owned health care systems are adding facility fees for inpatient care and for preventive and routine sick care provided by hospital owned "off-campus" primary care and OBGYN offices. Prenatal care, well care visits and adult checkups that once cost hundreds of dollars now cost thousands. States are now fighting back.

Smart payors are fighting back, too. They are having experienced negotiators, HHC Group's, use their expertise to identify facility fees and other over charges, and then get provider decision makers to accept an appropriate amount for both in and out-of-network claims. Year-to-date, HHC's clients are saving average of over 30% from the PPO discounted amount on successfully negotiated in-network claims.

The Fifth Circuit Court of Appeals has upheld a lower court decision that struck down key provisions of No Surprises Act (NSA) whose purpose was to reform surprise medical billing. In another victory for providers, the judges agreed with the Texas Medical Association, that first considering the Qualified Payment Amount when making their determinations is unfair conflicting with the goals of the NSA.

Glucagon-like peptide-1 (GLP-1) medications are having a seismic impact on people's health and on health care system costs nationwide. About 1 in 8 adults in the U.S. say they have taken a GLP-1. That number will only grow significantly if more insurance companies cover GLP-1 for weight loss. As costs skyrocket payors are scaling back or shuttering their bariatric surgery and weight loss centers while evaluating the potential long-term effect of GLP-1 on their strategic direction.