April 2019 Volume 21 Issue 4
Providing Current Information on

Health Insurance Industry Issues and Legislation

New Health Plans Lower Premiums, Greater Risks
The quest for less expensive healthcare coverage is spawning a wave of innovative
healthcare plan designs. While premium costs can be 15% to 30% lower than for
conventional offerings, most new plans place a greater burden on insureds to do
everything from negotiate with providers to file their own claims. Interpreting
Affordable Care Act rules in new ways, insurers are creating plans that avoid
consumers' annual in-network limits by calling additional charges "premiums" or
eliminating networks completely and paying a multiple of what Medicare would
have paid.
Reference Based Pricing Plans Need to Be Done Right
Referenced Based Pricing (RBP) can save payers significant amounts versus
traditional plans when "Done Right". Done Right starts with writing a Plan that
addresses the many issues unique to RBP. HHC Group helps write plans that avoid
problems before they happen. Done Right means having a RBP company able to
handle provider appeals. HHC Group has been successfully dealing with providers
and provider issues since 1995. Very importantly, Done Right means having a
robust program for handling balance bills. HHC Group does it right by assisting its
clients in educating Plan members about balance billing and what actions to take if
they get a bill. It means going to bat for the members and keeping them apprised
of what is being done and what they can do.
Paying Employees to Shop for Healthcare Pays Off
Paying employees to use a transparency tool and encouraging them to select a
lower-cost provider can generate saving for employers and money in the pockets of
employees, according to a new RAND Corporation study. Employees were offered
between $25 and $500 to use the tool. Employers saw the greatest savings (78%)
on ultrasounds and 25% on MRIs. Still only 8% of employees used the tool and only
about 1 in 4 of these chose the lower cost provider.
Americans Voice Their Healthcare Concerns
Americans are worried about rising healthcare costs both for themselves and for the
economy at large. A just released survey conducted by Gallup and the nonprofit West
Health found that Americans borrowed $88 billion to pay for healthcare last year. It
found people are skipping or deferring treatments because of their cost, and fear
bankruptcy in the event of a healthcare emergency. More than 3 in 4 are concerned
that rising healthcare costs will damage the American economy and have little
confidence in elected officials to control healthcare costs.
Three Star Preferred Provider Program Additions
Charlene Clark
Belfast, ME 04915

Nancy Damico
Port Richey, FL 34655

Pine Tree Recovery Center
Portland, ME 04103

Beaufort Memorial Hospital
Beaufort, SC 29902

P.D. Nayak, M.D.
Effingham, IL 62401

Marillac Clinic, Inc.
Grand Junction, CO 80501

Eye Services LLC
Jackson, MI49203