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210 Matching News Items

1.  Why Employers Are Fed Up With Payers Hiding Costs
HealthLeaders Media Link to more items from this source
Feb. 26, 2024
"Claiming that insurers consistently block access to this data, employers are saying it is increasingly difficult or even impossible to understand what they are being charged in their health plans. Despite a federal mandate that restricts health plans from limiting access to this valuable data, employers are still struggling to obtain it from insurers, turning to lawsuits as a last resort."
2.  No Surprises Act Disputes Continue to Rise; Providers Blame Insurers
HealthLeaders Media Link to more items from this source
Feb. 22, 2024
"From January to June 2023, over 288,000 disputes were submitted through the federal independent dispute resolution [IDR] portal. The IDR has struggled to keep up with the substantial number of submissions since the portal was opened in 2022. According to CMS, the majority of these disputes were initiated by a small number of providers, who have been vocal in their belief of insurers taking advantage of the law."
3.  Price Transparency Isn't Just a Compliance Measure
HealthLeaders Media Link to more items from this source
Jan. 21, 2024
"In a [recent survey] ... 93% of respondents said hospitals should be required to post their prices, not estimates, for planned care in advance."
4.  Inside Braidwood v. Becerra: Will Payers Waffle?
HealthLeaders Media Link to more items from this source
Oct. 23, 2023
"When a U.S. District Court struck down the ACA's Preventive Services Mandate, payers vocalized support for continued coverage. Health plan and employer group appeal briefs laud preventive services but point the finger at one another for putting future no-cost coverage at risk. This back and forth highlights one of healthcare's many if/then problems and how regulatory 'sticky floors' can help."
5.  UnitedHealthcare-Prisma Health Lawsuit Highlights Rising Tensions in Payer-Provider Negotiations
HealthLeaders Media Link to more items from this source
Sept. 11, 2023
"Inflationary pressures are putting strain on contract negotiations between payers and providers as the two sides work to iron out deals in a challenging financial climate. Many contracts that were agreed upon before the economy experienced record inflation are now coming to an end, but tensions are higher as providers and insurers battle over new terms."
6.  Providers Say Insurers Are Not Adhering to IDR Payments
HealthLeaders Media Link to more items from this source
Aug. 13, 2023
"Respondents said that 52% of payments determined by independent dispute resolution entities were not made at all by insurers, whereas 49% were not made in the 30-day timeframe, and 33% were made in an incorrect amount."
7.  Still Fielding No Surprises Act Questions? CMS Is Trying to Help
HealthLeaders Media Link to more items from this source
June 19, 2023
"CMS launched a webpage for consumers detailing patient protections from unexpected out-of-network medical bills under the No Surprises Act. The website also addresses the dispute resolution process for uninsured and self-pay patients interested in disputing their bill based on a provider's good faith estimate."
8.  Some Employers Unsure If They Will Cover Preventive Care
HealthLeaders Media Link to more items from this source
May 14, 2023
"Though 72% of employers [surveyed] said they expect to continue covering preventive services, 22% revealed they do not know whether they will provide coverage and 6% said they'll be more selective."
9.  No Surprises Act Working as Intended, But Gaps Remain, Leaving Patients Vulnerable
HealthLeaders Media Link to more items from this source
Apr. 30, 2023
"The analysis ... found that patients appear to be protected from services that previously left them exposed to surprise billing, like air ambulance services. Additionally, ... the NSA is 'getting consumers 'out of the middle' of payment disputes between providers and payors. However, gaps remains in the law for other services like ground ambulance, which one state regulator noted can result in patients being billed nine out of 10 times"
10.  PBMs, Employers Agree on Senate Transparency Bill: They Both Hate It
HealthLeaders Media Link to more items from this source
Mar. 23, 2023
"Despite the bad reviews, the bipartisan [Pharmacy Benefit Managers Transparency Act (S 127)] cleared the Senate Commerce, Science and Transportation Committee on Wednesday.... PBMs say the bill goes too far. Employer groups say the bill doesn't go far enough."
11.  Senators Target 'Loopholes' in Insurer Price Transparency Rule
HealthLeaders Media Link to more items from this source
Mar. 12, 2023
"Senators Maggie Hassan (D-NH) and Mike Braun (R-IN) wrote to CMS asking for changes to improve the payer price transparency rule. The changes include creating a standardizing reporting template, limiting file sizes, and requiring an organizational system and standardized labeling."
12.  Senate Cast Skeptical Eye on PBMs: 'Why the Hell (Do) They Even Exist?'
HealthLeaders Media Link to more items from this source
Feb. 16, 2023
"U.S. Senate Commerce Committee members on Thursday vented bipartisan confusion and frustration about the opaque, unregulated, and possibly anticompetitive practices of pharmacy benefits managers and their reputed role in driving up drug costs for consumers.... [The committee] met to discuss Pharmacy Benefit Manager Transparency Act of 2023 [S 127], a bill that would enhance state and federal oversight of PBMs."
13.  CMS Announces 600% Increase to No Surprises Act's IDR Fee
HealthLeaders Media Link to more items from this source
Jan. 19, 2023
"The nonrefundable administrative fee increased from $50 to $350. CMS says the case load of disputes is nearly ten times greater than initially estimated, resulting in the fee increase. Hospital groups fear this price hike will hinder medical groups from initiating the IDR process."
14.  With Price Transparency in the Limelight, How Much Are Patients Really Paying?
HealthLeaders Media Link to more items from this source
Nov. 15, 2022
"Using the average hourly earnings of residents of each state from the U.S. Bureau of Labor Statistics, researchers were able to calculate the number of hours of work required to pay off the bill for an average hospital stay. Oregon was the least affordable state, requiring residents to work 646 hours to pay for the average hospital stay. It was followed by Utah (600 hours), New Mexico (581 hours), Ohio (581 hours), and California (572 hours)."
15.  Lack of Price Transparency Deters One in Three Americans from Seeking Care
HealthLeaders Media Link to more items from this source
Nov. 2, 2022
"35% of people would be deterred from seeking care for themselves if they were unaware of the price ahead of time. Almost two-thirds (64%) of Americans don't know if their physicians or hospitals offer payment plans or financial assistance for medical bills."
16.  Takeaways from the American Action Forum on Employer-Sponsored Insurance
HealthLeaders Media Link to more items from this source
Oct. 18, 2022
"While noting declines in the percentage of people covered by their employers, the AAF panel asked multiple questions about the model's future and opportunities for reform."
17.  Healthcare Costs for Employer-Sponsored Plans on the Rise
HealthLeaders Media Link to more items from this source
Sept. 18, 2022
"Health insurers and administers surveyed reported medical trend factors that vary by product, averaging 5.8% to 6.9%, down by 1-2 percentage points from the previous survey. The Preferred Provider Organization plan was at 6.4% for the average trend factor, down by 1.4% from the prior year. With prescription drugs, insurers reported a weighted average trend of 8.1%, down 0.7% from 2021, whereas the weighted average trend reported by Pharmacy Benefit Managers increased from 6.2% to 7.5%."
18.  Smaller Hospitals More Likely to Be Noncompliant with Price Transparency Rule
HealthLeaders Media Link to more items from this source
Sept. 14, 2022
"While price transparency compliance ranged from 13% to 49% of hospitals studied, the findings revealed that facilities with fewer beds were less likely to be compliant with the rule. Additionally, hospitals located in the South and the West were also associated with less transparency."
19.  Employer Healthcare Costs Set to Increase by $13,000 Per Employee in 2023
HealthLeaders Media Link to more items from this source
Aug. 28, 2022
"[Aon] used data of nearly 700 employers representing approximately 5.6 million employees and found that healthcare expenditures will rise significantly from the budgeted $13,020 per employee in 2022. The projection of a 6.5% increase is more than double the rate employers experienced from 2021 to 2022"
20.  Cleveland Clinic Expands Centers of Excellence Program for Self-Insured Businesses
HealthLeaders Media Link to more items from this source
July 8, 2022
"The health system has added two new centers, covering musculoskeletal and bariatric health, to its program, giving business leaders a direct link to specialist services and allowing them to better manage employee healthcare costs.... Businesses are choosing this model not only to reduce the complexity of health plans and cut administrative costs, but to better manage soaring employee healthcare costs and boost health and wellness through more focused, evidence-driven care programs, including preventive care."
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