The Biden Administration Will Fine Companies of All Sizes for Not Complying with the Transparency in Coverage Rules of the Affordable Care Act Health Plans, management consultants, TPA’s, and advisory brokers are being held accountable by employer groups to ensure compliance. Meanwhile, opportunistic vendors providing fractional solutions are underserving in this critical venture, leaving significant …
Larger companies typically sponsor self-funded health plans in which the employer pays most medical bills directly and hires third-party administrators to handle claims and help design plans. Those plans aren’t subject to the ACA’s medical loss ratio rules, but they can be affected. “When you look at the administrative services-only parts of those same entities, …
Insurers’ ‘Gaming’ of Obamacare Provision Seen Boosting Premiums Read More »
An extraordinary transformation in commercial health insurance will begin on January 1 when the federal regulations known as the No Surprises Act and the Transparency in Coverage Rule usher in a new market-driven healthcare system. Many in the health insurance ecosystem view the requirements as hopelessly complex and onerous. Not us. TALON views these mandates …
Our Take on the No Surprises Act, Transparency in Coverage Rule Read More »
Join us on Thursday, January 20th for TALON’s first webinar in our series highlighting how to understand, assess, and prepare for this transformative legislation. TALON will highlight the critical steps to ensure compliance for key commercial health insurance stakeholders; employers and employees; plan advisors and brokers; and third-party administrators, ASOs, and insurance carriers. The webinar …
Addressing the need for employers, commercial health insurance advisors and brokers, third-party administrators, ASOs and carriers to find clarity and a path forward regarding numerous mandates contained within the No Surprises Act and Transparency in Coverage Rule, TALON has published its Planning Guide, Ensuring Compliance with the No Surprises Act and Transparency in Coverage Rule. …
TALON Publishes Planning Guide For No Surprises Act, Transparency in Coverage Compliance Read More »
TALON has recently licensed its turn-key solution for federal No Surprises Act and Transparency in Coverage Rule compliance and safe harbor to leading third-party administrators (TPAs). “These TPAs are poised to not only protect clients against the financial risks of non-compliance, but also to take full advantage of America’s new market-driven healthcare system that begins …
The No Surprises Act prohibits balance billing in the case of surprise medical bills — those for non-emergency services furnished by out-of-network providers during a visit by the patient at an in-network facility — unless the law’s notice and consent requirements are met, according to the Interim Final Rule published earlier this summer. Out-of-network providers …
TALON defines healthcare “price transparency” to be accurate and easily accessible information intuitively presented on the price of health care services and items that helps define the value of those services, enabling patients and other healthcare cost stakeholders to identify, compare, and choose providers based on cost, quality, and convenience. It is important to note …
I’ve written previously about the blight of complacency that has descended upon employer-sponsored health insurance. Much of the growth of the unsustainable cost-curve experienced by employers and their employees arises from the complacency of benefit advisors, employers, and their employees. Employee benefit costs—namely, healthcare—appear as the second largest expense item for many employers. Yet benefit …
Passive Healthcare Consumers = Exploited Healthcare Consumers Read More »
Within health plan design offerings, there are four categories, or metal levels, made available to employers and their employees. These levels are listed by the split of costs between the enrolled individual and the health plan. See chart below: How you and your insurance plan split costs The decision process behind enrollment within these plans …
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