Phia Group Media


Phia Group Media

Empowering Plans: P49 - Issues with Inaction: Balance Billing and Wellness Programs

On July 23, 2018

In this episode, hosts Jennifer McCormick, Brady Bizarro and Erin Hussey discuss issues with inaction. The first issue is with balance billing, and a recent case involving a patient who was balance billed and refused to pay the bill. The hospital now seeks declaratory judgement stating that the patient-hospital contract is valid. This case is a good example of the interaction of third party agreements and the SPD, and the ongoing issue of the reasonableness of Chargemaster rates. The second issue is with wellness incentive rules and the lack of guidance from the EEOC, following the AARP v. EEOC case. This EEOC was ordered to re-write wellness program rules regarding incentives and issue proposed rules on August 31, 2018, with an effective date of January 1, 2019. If the EEOC does not re-write the rules, the old rules (the 30% incentive maximum) will be vacated and there will be no new rules for employers to follow.

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