On July 31st at 1 PM EST, The Phia Group’s CEO – Attorney Adam V. Russo – and The Phia Group’s Sr. VP and General Counsel – Attorney Ron E. Peck – will address one of the most pressing issues facing our industry today – balance billing. In particular, they will discuss what benefit plan administrators can do to assist their participants and push back against this problem.
To maintain benefit program viability, employers are cracking down on excessive spending through auditing and implementing new methodologies, such as cost based reimbursement and Medicare pricing, in addition to traditional network policies. In this new environment, participants will be thrust into the fray like never before; exposed to the threat of balance billing.
Topics that will be discussed include, but are not limited to –
• When strict enforcement of the plan terms and preventing balance billing may not be harmonious goals
• Undertaking efforts on behalf of benefit plans to resolve disputes with providers so that participants benefit as well, compared to “patient advocacy”
• Providing support to participants facing balance billing by explaining why the payments were capped, describing the appeals process in detail, and providing arguments they can raise against the provider
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A Delay In Play (or Pay) – The News Isn’t As Good As You May Think
The Obama administration announced that it is postponing the requirement that employers provide employees robust, affordable health plans; also known as “pay or play.” You may think that this is good news… It’s another year to consider options, prepare funds, and study the intricacies of PPACA. DON’T BE FOOLED!
Regulatory officials have stated that the delay was prompted by so-called “compliance complexity concerns.” Employers have attacked the rule from every angle; targeting unrealistic expectations, costs, and difficulties in reporting. In addition, many employers have threatened to “trim” their employment rosters. Employers with fewer than 50 employees (or full-time equivalent employees) are exempt from the rule. It should have come as no surprise, then, that some employers were going to cut employees’ hours or terminate staff, dropping below 50 lives. With all of this in mind, the administration – “thankfully” – pulled back on the reins. Great news, right? Wrong!
At The Phia Group, we hope for the best but plan for the worst. For the following reasons, now is not the time to disregard cost containment efforts. – Read More