August 2017 Volume 19 Issue 8
Providing Current Information on

Health Insurance Industry Issues and Legislation

Overtreatment of Lower Back Pain Costing Billions
An estimated $86 billion dollars is spent on the treatment and management of lower back pain in the U.S. annually. According to a Health Affairs blog, much of that money is wasted or worse, being spent providing health care services for which the potential harm outweighs the potential benefits. The contributors to the wasted billions and harmful overuse are many and the costs continue to skyrocket.
Doctors, Hospitals Wage War on Price Transparency
The battle over price transparency is being fought in states throughout the U.S. Ohio's Healthcare Price Transparency Law mandates that providers must give patients a "good faith" estimate of the cost of non-emergency services before they start treatment. The law was scheduled to go into force on January 1 of this year. However, due to legal challenges from the Ohio Hospital Association and a wide range of providers, the law has never gone into effect.
Provider-Sponsored Plans Finding Tough Sledding
Health systems are finding that the healthcare insurance business is not as easy as it looks. Many systems that started their own health plans find themselves bleeding red ink. Some, like Catholic Health Initiatives of Englewood, Colorado and Tenet and Tenet Healthcare had gotten out of the business altogether. Others, like Northwell and CareConnect are retooling their business plans with the hopes of stemming their losses and staying in the business for the long hall.
When Providers Balk, Our Bulldogs Bark
More and more employers with self-funded health plans are turning to reference-based pricing to reduce their overall spend. They like the deep savings and they appreciate the price predictability regardless of which provider the plan member uses.

Of course, some providers may balk at the reimbursement amount even with a clear Explanation of Payment (EOP).

That's okay, because HHC Group's bulldogs will bark when they balk.

For all our plans that utilize reference-based pricing services we're available to address provider appeals from explanation of payment to direct negotiation. And we support these types of appeals whether we reprice all your client's claims, only hospital claims, only physician claims, out-of-network claims, or specialty services claims.

CLICK HERE and see how we bark back at providers who refuse referencebased pricing.

Or reach us directly at 301.963.0762 ext. 163 or by emailing sales@hhcgroup.com
THREE STAR PREFERRED PROVIDER PROGRAM ADDITIONS
IGG America, Inc.
Chicago, IL, 60693

Florida Keys Radiology Associates
Marathon Shores, FL 33052

Verralab JA
Louisville, KY 40209

Baptist Medical Center
Jacksonville, FL 32207

MSC Inc. DBA Lymphacare
Montgomeryville, PA

The Therapy Tree LLC
Lake Villa, IL 60046