News & Insights


High Court Ruling May Hinder Plans’ Efforts to Recoup Consumers’ Legal Awards

Accidents happen, and if they’re someone else’s fault, you can go to court to try to get compensation for your medical expenses, lost wages, and pain and suffering. If you win, though, the pot of gold you receive may be considerably smaller than you expect: Your health plan may claim some or all of it as reimbursement for money it spent on your medical care. Read more.

Businesses Sue Major Provider Network in California

Businesses in California are going to war with one of the Golden State’s largest medical providers over the cost of care. A group of companies is suing Sutter Health, a nonprofit network of hospitals, clinics, and doctors in northern California, accusing it of anticompetitive practices and price gouging. Read more.

Coalition Says Transparency, Value-Based Pay Could Contain Drug Costs

Increased transparency and competition in the pharmaceutical industry and expanded value-based payment models would help address rising prescription drug prices, according to a coalition aimed at containing costs. The Campaign for Sustainable Rx Pricing said multiple organizations representing doctors, nurses, hospitals, insurers and consumers have endorsed the proposals to fix what they say is a broken market for prescription drugs. Read more.

Why Plan Sponsors Should Be Upfront With Workers about Self-Funding

How can an employer sponsoring a self-funded health plan effectively communicate to its employees that the plan is self-funded and explain why that’s important? First, eliminate the terms health insurance company and health insurer from the employee communication materials and strive to eliminate the terms from the company vocabulary. Read more.

Florida Governor Signs Law Shielding Patients from Surprise Medical Bills

The movement to protect consumers from surprise medical bills won a major victory Thursday when Florida Republican Gov. Rick Scott signed a bipartisan bill that will exempt patients from having to pay balance bills from out-of-network providers in certain situations. The new law will apply to patients who go to a healthcare facility in their health plan network and inadvertently receive services from a non-network provider. Read more.

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