Secrets to Making Reference-based Pricing Work

MyHealthGuide Source: Adam Russo, Esq.,1/14/2016, Thompson Information Services Blog In order for reference-based pricing (RBP) to work, health plan sponsors should do it in a way that involves implementing best practices for cost analysis, claim repricing, plan design, patient advoca
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Florida Business Coalition Set to Revolutionize Health Benefits Purchasing

By Dave Chase Template Set for Business Coalitions on Health Around the Country After many years of de minimis impact on slowing healthcare’s hyperinflation, business coalitions are doing a strategy reset . Historically, the business coalitions I’m familiar with have been “captured” b
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The Phia Group’s January 2016 Webinar – Register Now!

Saving Stop-Loss: Protecting a Key Self-Funding Ingredient in a Hostile World Tuesday, January 19th, 2016 1:00 PM (EST) to 2:00 PM Join Us – Register Today! Stop-loss insurance is one of the – if not the – most important piece of the self-funded puzzle. Attempting to
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What’s behind the Clinton-Sanders health care fight?

By Eric Bradner and Tami Luhby, CNN The two leading Democratic presidential candidates’ escalating feud over health care has become a defining issue in the 2016 primary campaign as they approach the final debate, Saturday in South Carolina, before voting begins. Here’s a l
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A few Ala. counties halt marriage licenses to gay couples

By Brian Lyman, Brad Harper and Andrew Yawn, The Montgomery (Ala.) Advertiser MONTGOMERY, Ala. — An order from the chief justice of Alabama’s Supreme Court aimed at thwarting the availability of same-sex marriage in the state seems to be having little effect, according to calls
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Obama vetoes Obamacare repeal effort

By Dan Cook As expected, President Barack Obama vetoed a Republican-backed measure that would have repealed the Patient Protection and Affordable Care Act. Read more…
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First Quarter Newsletter 2016 – The Stacks

The Power of the Plan Document, by Adam V. Russo, Esq. Just the other day I heard the strangest comment from someone that I truly respect and was kind of shocked to actually hear. One of the top executives in the self insured industry was talking to me about self funded employee benef
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Emory Employees Barred from Cancer Tx at Competitor

By Eric T. Rosenthal Employees of Atlanta’s Emory University are no longer allowed to seek cancer treatment — and get it paid for by their Emory-sponsored health insurance — at a Cancer Treatment Centers of America (CTCA) clinic. Read more…
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Anti-Assignment Clauses Bar Provider’s ERISA Claims

By Carmen Castro-Pagan An out-of-network health-care provider can’t continue with her claims under the Employee Retirement Income Security Act for unpaid benefits, fiduciary breach and failure to disclose documents against four health benefit plans, the U.S. Court of Appeals for
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The Phia Group’s January 2016 Webinar – Register Now!

Saving Stop-Loss: Protecting a Key Self-Funding Ingredient in a Hostile World Tuesday, January 19th, 2016 1:00 PM (EST) to 2:00 PM Join Us – Register Today! Stop-loss insurance is one of the – if not the – most important piece of the self-funded puzzle. Attempting to
Continue Reading →