Consumer Protections are coming to Healthcare

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 …

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True Price Transparency means “No Surprises”

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 …

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Passive Healthcare Consumers = Exploited Healthcare Consumers

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 …

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The New Definition of Plan Metals

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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Health Insurance Premium Rebate Checks Aren’t Good News for America

Ever since 2012, Americans have received rebate checks from their health insurers when the Medical Loss Ratio doesn’t “measure up” to the 80/20 Rule.  In simple terms, the Rule means that insurers must spend 80 percent of their revenue from premiums to pay for the healthcare of their subscribers.  The other 20 percent is theirs to keep.  What …

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An Act of True Bipartisanship: The No Surprises Act

On July 1, 2021, the Biden Administration issued its interim final rule cementing into place the No Surprises Act, which was signed into law by the Trump Administration on December 27, 2020.  The Act is one of the most important consumer protection measures regarding healthcare—ever.  It takes effect on January 1, 2022.  And in these days of so …

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The Transparency in Coverage Rule and the No Surprises Act: A Millennial’s Perspective

The Transparency in Coverage Rule and the No Surprises Act, set to take effect on January 1, 2022, will have a momentous impact on employer-sponsored health insurance, in terms of cost, as well as consumer knowledge. These rules will impact millennials, in particular, because they speak to one of the key characteristics of this demographic—the …

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Vincible Ignorance – One of the Problems with ESHI

Employer-sponsored Health Insurance (ESHI) covers just over 55 percent of the U.S. population and accounts for just over a third of the overall health care expenditure for the country. With such significant dollars allotted, expectations for the quality of healthcare and the overall health of individuals would be at the top of every health-related metric …

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Five Steps to Increasing Employee Engagement with Transparency in Coverage

With the Transparency in Coverage Rule and No Surprises Act taking effect January 1, 2022, TPAs, ASOs, Insurers and employers of every kind should be focusing not just on meeting the requirements of the Rule and Act and avoiding fines of up to $100 per member per day, but also on increasing employee engagement with …

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How Nostalgia is Misleading Employee Health Plans

Matthew McCormick, Director, Partner Sales Having spoken with and met hundreds, if not thousands, of employee benefit brokers, I’ve noticed a recurring, fundamental theme runs through our discussions: .. Many within the healthcare space have been led astray by nostalgia. Nostalgia is a beautiful word It brings back fond memories. It evokes a sense of …

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