Surprise Balance Billing
States are taking the lead to address surprise balance bills – charges for unexpected, out-of-network medical care – by enacting consumer protection laws that range from strict requirements for network service disclosures to outright bans on balance billing in certain circumstances. NASHP is tracking state efforts to mitigate surprise billing and analyze the outcomes of these measures.
In late June, the US District Court for the District of Columbia upheld the Department of Health and Human Services’ (HHS) 2019 transparency rule that requires hospitals to make public five standard charges, including their chargemaster rates and rates paid by private payers by Jan. 1, 2021. A coalition of hospital groups and hospital systems […]
COVID-19 has profoundly affected the health care landscape, raising anew concerns about the high cost of hospitalizations while simultaneously placing new burdens on those facilities and curtailing non-emergency services. Providers, unable to see patients for routine care, lost revenue and many free-standing physician practices are now at risk, and now face increasing pressure to merge […]
The importance of COVID-19 testing is clear, especially as new cases climb dramatically, reversing earlier successes at controlling the spread of the disease. Lack of a coordinated, federally-led testing initiative and protocols has prompted questions about how often testing should occur, whether both symptomatic and asymptomatic should be tested, and who should pay for it, and in what circumstance. As states […]
As states loosen restrictions on stay-at-home orders, many are struggling to establish clear and consistent COVID-19 testing protocols to support individuals’ safe return to work and school and identify ways to pay for increased testing. Absent federal guidance, there is significant debate about who is responsible for funding testing – insurers argue a test must be medically necessary and employers […]
Removing wasteful drugs from formularies and replacing them with drugs that offer the same benefits at a lower cost, helps state employee health plans and other public purchasers reduce spending without sacrificing value – a critical strategy for savings as states face tremendous budget pressures.
Last week, the Internal Revenue Service (IRS) released a proposed rule that would for the first time allow tax deductions for money spent for certain health care programs and arrangements, including direct primary care arrangements and health care sharing ministries.
State employee health plans (SEHPs), which provide health coverage for millions of public employees, their dependents, and some retirees, are making rapid changes to address the COVID-19 pandemic. This retooling of insurance plans must meet emerging federal requirements and ensure that coverage meets enrollees’ needs while managing costs and anticipating budget constraints. During a recent […]
States are experiencing a huge rise in the number of people without health insurance in the wake of mass layoffs resulting from the COVID-19 pandemic and are seeking strategies to protect them from high prescription drug prices. The uninsured are sometimes the only consumers left paying the full list price for a drug, while the […]
As COVID-19 diagnoses grow, states are making rapid-fire adjustments so consumers can access the care they need. One key strategy has been promoting health insurance enrollment to protect consumers from potentially exorbitant medical bills. Recognizing more protection is needed, state insurance regulators are also making sure consumers maintain their coverage, find appropriate care, and are […]