Costs Can Go Up Fast When E.R. Is in Network but the Doctors Are Not

By ELISABETH ROSENTHAL When Jennifer Hopper raced to the emergency room after her husband, Craig, took a baseball in the face, she made sure they went to a hospital in their insurance network in Texas. So when they got a $937 bill from the emergency room doctor, she called the insurer
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8 major takeaways from ERISA litigation in 2014

Employee Benefit Advisor This has been a busy year in the courts, with litigation challenging a variety of issues in the employee benefits arena. Here are the eight major takeaways from 2014 litigation and impending cases with key lessons for fiduciaries, employers and benefit adviser
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Ocean Surgery Center offers cash prices on the West Coast

Posted by sean@impactpolicymanagement.com I’ve written about and mentioned on several occasions two surgical facilities that offer cash prices for self-pay patients, the Surgery Center of Oklahoma and Regency Healthcare in New York City. These are places that offer up-front, all-inclu
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After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know

By ELISABETH ROSENTHAL Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms. A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox H
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NAIC White Paper

WHITE PAPER STOP LOSS INSURANCE, SELF FUNDING AND THE ACA I. Introduction Since the passage of the Patient Protection and Affordable Care Act of 20101 (ACA), there has been a lot of speculation about its potential impact. The goal of the law is to make affordable, quality health insur
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Texas C.P.R.C. c. 140: The New Standard for Subrogation Rights

Texas health plans seeking reimbursement via subrogation, are now forced to deal with new guidelines. C.P.R.C. c. 140, governing subrogation, went into effect January 1, 2014; enacting H.B. 1869, which was passed months prior; but the finer points are still being explored. Who Does Th
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‘Striking change’ in employer-sponsored health care premiums

By Leah Shepherd The days of double-digit health insurance premium increases seem to be behind us, according to a study released today by the Kaiser Family Foundation and the Health Research & Educational Trust. Read more…
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SIIA State Legislative/Regulatory Update Report

Exclusive Reporting for the Week of September 10, 2014 September 10, 2014 — This is your weekly update of state legislative/regulatory developments affecting companies involved in the self-insurance/alternative risk transfer marketplace. Should you have any questions on informat
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Full D.C. appeals court expected to uphold ACA subsidies

By Paul Demko and Bob Herman The District of Columbia U.S. Circuit Court of Appeals in Washington on Thursday said the full 11-member court will rehear (PDF) the controversial case that ruled Americans could not receive subsidies to help pay for plans on federally run health insurance
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State Legislative/Regulatory News

Self-Insurance Institute of America, Inc. Exclusive Reporting for the Week of September 4, 2014 September 4, 2014 — This is your weekly update of state legislative/regulatory developments affecting companies involved in the self-insurance/alternative risk transfer marketplace. S
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