December 2020 Volume 12 Issue 13
Providing Current Information on

Health Insurance Industry Issues and Legislation

COVID-19 Test Price Gouging
A new America's Health Insurance Plans survey found that price gouging on out-ofnetwork
(OON) COVID-19 tests has only gotten worse since the last survey taken in July. In
October, an average COVID-19 diagnostic or antibody test in the commercial market cost
$130; an average OON test cost more than $185. Even worse, somewhere between 9%
and 16% of these OON test providers charged more than $390.
Reigning In Those Overpriced Claim Costs
As out-of-network providers continue to charge continually increasing amounts for
COVID-19 tests and other healthcare services, it is more important than ever to have
highly skilled, experienced negotiators, like HHC's attorneys, fighting to ensure you
are paying only the appropriate amount for those tests and services. It's also essential
to have nurse experts, like those used by HHC, to comb through claims line by line to
ferret out costly unbundling, duplications, inappropriate charges and other errors.
Healthcare Micro-Trends, Predicting the Future
As a result of the COVID-19 pandemic, preventive care visits are down. Immunizations
and cancer screenings are down. Colonoscopies alone have decreased 95%. Inpatient
and outpatient elective surgeries are down with hip and knee replacements down
80% - 90% or more. People are delaying routine, acute and chronic care. Mental
health needs are skyrocketing. How will each impact people's health and utilization
of healthcare services as well as benefit cost in 2021?
Digital Health Benefits - The Future Is Here
Until the COVID-19 pandemic, basic digital health benefits - telehealth, wearables,
online provider searches, etc. had gone mostly unused. Now, use is surging.
Additionally, more and more innovative apps are coming to market that employ
digital therapeutics to help manage chronic conditions and pain, and control costs.
Employees recognize their value with more than 25% of American workers now saying
they are willing to leave their present jobs to go to an employer that offers digital
health benefits. The key is what plans do to make their employees aware of these
benefits and actively encourage them to use their digital benefits to manage their
health safely and at lower cost.
H.H.C. Group Services
Medicare Reference Based Pricing Claim Negotiation Claim Repricing
Medical Bill Review (Audit), Claims Editing DRG Validation Specialty Drug Cost
Containment Medical Peer Reviews/Independent Reviews, Utilization Reviews
Independent Medical Examinations (IME) Pharmacy Consulting.

H.H.C. Groupis an URAC accredited Independent Review Organization for Internal and
External Reviews.

For additional information about H.H.C. Group and cost containment services, please visit www.hhcgroup.com or contact Dean Vaden at dvaden@hhcgroup.com or 727-253-0365.
Three Star Preferred Provider Program Additions
North Star Guidance LLC
Salina, KS 67401

Cormeum Lab Services LLC
Marrero, LA 70072

Med-Lake Laboratory LLC
Milledgeville, GA 31061

Natera, Inc.
San Carlos, CA 94070

Prairie Band Potawatomi Health Center
Mayetta, KS 60509

Anesthesia Associates LLP
Manhattan, KS 66502