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Surprise Medical Billing Reaches a Tipping Point

David Rook

All across the country, a sweeping movement to combat surprise medical bills has been slowly percolating and is now finally gaining traction on a national level.

What began as grievances filed by wronged patients has grown into government officials at both the state and federal level championing legislation against this industry practice.

A law that recently went into effect in Arizona and recent remarks from President Trump are merely the latest in an ongoing trend that has the force to reshape how patients are billed for out-of-network expenses.

Unexpected Out-of-Network Charges Result in Surprise Medical Bills

Surprise medical billing isn’t so much an intentional practice of healthcare companies, as much as it’s a byproduct of the fractured healthcare industry. Specifically, it’s a result of multiple institutions and providers treating patients simultaneously while working for different employers.

In its simplest form, a surprise medical bill is an unexpected medical bill that patients receive for out-of-network services that they thought were in-network. The bill is sent after the services are provided, leaving patients with little recourse and high fees since out-of-network charges tend to be much higher than those in-network.

An all too common scenario shows how easy this can happen to patients. A patient goes to a hospital for a covered surgical procedure. They’ve done their research and have made sure that both the hospital and the surgeon’s practice are within their insurer’s network. In completing this due diligence, they then assume that the entire procedure will be covered as an in-network expense. Seems reasonable, right?

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Topics: Cost Containment, Legislation, trends, Arizona, healthcare costs, Arizona Regulations

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The State of the Union Address and What It Means For Employee Benefits

Jeff Griffin

Last week, President Donald Trump delivered the 2019 State of the Union Address (SOTU). The SOTU is an annual message delivered by the president to a joint session of Congress at the beginning of each year.

At this year’s SOTU, President Trump discussed issues that have the potential to impact the employee benefits industry, as well as employers offering healthcare and benefits to their employees. The issues he discussed included pre-existing conditions, lower prescription drug prices, and nationwide paid family leave.

While the SOTU is just a speech, often times packed with lofty aspirations, it does sometimes lead to policy. Here is a recap of what was addressed:

Pre-existing Condition Protection

In a departure from 2018 Department of Justice actions, President Trump announced in the address that people who have pre-existing conditions should receive protections. If the administration holds true to this goal, they will likely find cross-aisle support, as pre-existing condition patient protection was a key campaign issue in the midterm elections.

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Topics: Paid Time Off (PTO), Legislation, Prescription Drugs, Pre-Existing Conditions

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Trump's Plan To Reduce Prescription Drug Prices

Jeff Griffin

So it was with great interest that we took note of last Friday’s White House Rose Garden announcement by President Trump to “bring soaring drug prices back down to earth” by promoting competition among pharmaceutical companies, and giving private entities more tools to negotiate better deals on the behalf of consumers, insurers and employers.

Somewhat surprising in his announcement was his abandonment of some of the more populist proposals which he boasted about during his presidential campaign, including his promise to authorize the Feds to negotiate directly with drug companies in an effort to lower Medicare drug prices and disallowing American consumers from importing low-cost prescription drugs from overseas.

Nevertheless, both Republican and Democrats (as well as all of us here at the JP Griffin Group) welcomed the President’s attention on combating high drug prices. The looming question remains just how the President’s promises to lower drug prices will play out and if the concepts proposed will ever come to pass.

We certainly hope the plan gains traction as both employers and employees alike could sure use a break from escalating drug prices which have now become a primary driver of health-related expenditures.

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Topics: Cost Containment, Legislation, CFO, Pharmacy, Prescription Drugs

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Alternative Health Plan Options For Small Employers: MEWAs and AHPs

Jeff Griffin

Employers have been struggling to find the best way to provide affordable health benefits to their workers for many years now. One promising option, especially for those with smaller workforces, is to offer insurance through multiple employer welfare arrangements (MEWAs) and association health plans (AHPs).

The idea behind MEWAs is to bundle small groups into a larger community, thereby spreading risk over a larger and more diverse pool of covered individuals. It’s the same principle large employers benefit from by way of lower insurance premiums.  

If your small business is looking for cheaper healthcare options, MEWAs and association health plans may be good options for you to investigate.

What is a MEWA?

MEWA stands for multiple employer welfare arrangement, but is also sometimes referred to as a multiple employer trust (MET). MEWAs allow small employers to essentially team up to create a larger pool of employees to capitalize on the economies of scale that larger employers enjoy. This could mean as few as two employers in the group, or as many as deemed necessary to form a large enough employee pool.

Each employer gets a say in plan design, as well as plan offerings. If one employer has an older population who prefers more traditional plans, they can request such for their workforce. If another employer has a younger workforce for whom high deductible health plans would be more appealing, they could request more consumer-driven healthcare options for their employees. With these groups banded together, the premium costs should be lower than if each employer tried to get insurance on their own.

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Topics: Employee Benefits, Compliance, Cost Containment, ACA, Legislation, Association Health Plans, MEWA

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Sample Policies for Arizona's New Paid Sick Leave Law

Jeff Griffin

In the November 2016 general election, Arizona voters passed Proposition 206, which instituted an incremental increase in the state’s minimum wage, as well as mandated paid sick leave for all employees — not just full-time, but part-time, temporary, and seasonal workers as well. All HR professionals and business owners should be apprised to the changes this law will bring and what it means for themselves and their employees.

To assist with complying with the new law, we're providing you with sample paid sick leave policies, not only for employers with over 15 employees, but also for employers with under 15 employees. Feel fee to use these new sample policies in posters, updated employee handbooks, and wherever else you post your HR policies. Of course as always, you should consult with your legal council and benefits advisor to ensure accuracy and applicability to your business,*

Here's a recap of the new law.

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Topics: Employee Benefits, Paid Time Off (PTO), Legislation, Arizona

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Senate's ObamaCare Replacement Bill Would End Employer Mandate

Jeff Griffin

Determined to pass health care legislation before the July 4th break, the Senate on Thursday night released a draft ACA replacement bill called the Better Care Reconciliation Act (BCRA). As of this morning, at least five Republican Senators have said they won’t vote for the bill. GOP Senate leaders can only afford to lose two members of their 52-senator caucus in order for the bill to pass. (The loss of two would require Vice President Pence to cast the tie breaking vote, assuming not a single Democrat supports the bill.)

While passage as the bill stands now seems dubious, Republicans and the White House see this as one of the last chances they have to pass healthcare legislation before they can move on to tax reform, so amendments are likely to win back some of these Senators. That process, however, could push the vote to after the July 4 break. Still, Majority Leader Mitch McConnell is a seasoned politician, and many pundits doubt he’d call for a vote before the recess if he didn’t have a few aces up his sleeve.

Let's look at several elements of the bill which are particularly pertinent to employers:

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Topics: Employee Benefits, Affordable Care Act, ACA, Legislation, PPACA

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Arizona Healthcare Could Improve with New Legislation

David Rook

State lawmakers are currently reviewing a piece of legislation that could improve Arizona healthcare for a number of residents. Senate Bill 1441 seeks to solve a common Arizona healthcare problem: surprise medical bills from out-of-network physicians after receiving treatment or having surgery through in-network providers. It’s a frustrating (and confusing) situation, especially for those who have done their research beforehand to make sure all providers were covered by their insurance policy. How are people getting unexpected bills? And what will this legislation do about it?

The Arizona Healthcare Problem: Surprise Bills

In the state of Arizona, people seeing in-network doctors and utilizing in-network hospitals systems frequently receive surprise bills from out-of-network providers. It’s become a common Arizona healthcare narrative these days. If it hasn’t happened to you, you probably know someone who has encountered this issue in the past.

How does this happen? Well, it’s actually pretty complicated.

Let’s say you need surgery. You do your necessary diligence by researching the hospital, the surgeon, and the other doctors you know you’ll be in contact with. You make sure they’re all in-network so you’re minimizing the bills you receive after the fact. Everyone (including the hospital network) is covered. You should be all set, right?

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Topics: Employee Benefits, Compliance, Legislation, Arizona

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Possible Healthcare Legislation Changes and How They Could Affect Employers

Jeff Griffin

Since the inauguration of a new president in January, healthcare legislation to replace the Affordable Care Act (ACA) has been a hot topic of conversation, not only among employers and healthcare providers, but many American citizens as well. Multiple rumors have been making their way down from Capitol Hill, but it appears as though we finally have some concrete ideas from House Republicans — even if they aren’t fully fleshed out in terms of finances

Regardless of what healthcare legislation is passed, it is largely expected that the employer mandate will be repealed, which will have some sort of effect on many American employers. Let’s take a look at the proposed healthcare legislation and other documents from the Department of Health and Human Services (HHS) to determine what employers might be able to expect from lawmakers in the coming months.

The New GOP Healthcare Bill

On Monday, March 6, 2017, House Republicans released what is being collectively referred to as the American Health Care Act (AHCA), which is intended to partially repeal, but also replace the ACA. As anyone might expect in a heated political climate, the proposed healthcare legislation has been met with mixed reviews.

The proposed bill would keep some of the popular components of the ACA, such as the provisions that prohibit insurance companies from denying coverage based on pre-existing conditions or capping the amount of benefits received in one year (or a lifetime). In addition, people would be allowed to remain on their parents’ health insurance plans up to age 26.

While pre-existing conditions would no longer be a reason insurance companies could deny coverage, they would be allowed to charge up to 30 percent more for enrollees who let their coverage lapse. Coverage lapses are common among those suffering from chronic illnesses or serious medical conditions because they are likely to miss work for an extended period of time. Since the Family Medical Leave Act (FMLA) only protects workers for 12 weeks, those receiving extensive treatments (such as chemotherapy) are some of the most commonly affected by lapses.

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Topics: Employee Benefits, Employer Mandate, Legislation

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Where The Presidential Candidates Stand On Employer Sponsored Healthcare and Employee Benefits

Jeff Griffin


Americans are concerned about the future of their health care system—and for good reason. It's projected that we will spend 4.5 trillion dollars on health care in 2019 and five trillion by 2022.

According to a recent study from the Society for Human Resource Management, 79 percent of employers that provide health insurance are "very concerned" about rising health care costs. HR professionals know health care concerns go well beyond the effects on the organization's bottom line. Health care benefits play a critical role in recruitment, retention, employee morale, and productivity.

So, where do the presidential candidates stand on employer-sponsored health care and employee benefits?

 

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Topics: Employee Benefits, Education, Legislation

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Where The Presidential Candidates Stand On Employer Sponsored Healthcare

David Rook

The healthcare debate hasn't been as tumultuous this election cycle as it has been in the past, but regardless of who sits in the Oval Office in January, there will be changes in employer sponsored healthcare. Here's what you need to know about potential legislative changes and employee health benefits.

The Democrats

Hillary Clinton:
After years of championing a single-payer system, Clinton shifted her stance to fully support the Affordable Care Act with a plan to extend current legislation. She has stated that building upon the Affordable Care Act is a more practical solution than instituting a single-payer system, but acknowledges flaws in the existing ACA. Notably, high deductibles and premiums. Her plan incorporates increased tax credits to offset high premiums and other out-of-pocket costs. She also plans to "fix" the "family glitch" so that families can make up the gap in costs between employer coverage and health care costs. Under Clinton's plan, little will change for employers but consumers can expect to see relief in the form of expanded public options and tax credits.

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Topics: Employee Benefits, Education, Legislation

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