February 2019 Volume 21 Issue 2
Providing Current Information on

Health Insurance Industry Issues and Legislation

The Fight Over Surprise Out-of-Network Bills Heats Up
Everyone seems to agree that consumers should get relief from surprise medical
bills. The fight over how to achieve the goal is raging hot and heavy in Washington.
On one side are emergency room physicians, anesthesiologists and other providers
who favor arbitration. On the other are insurers who want some other benchmark.
With inter-industry finger pointing, slippery slope warnings regarding rate setting
and dueling narratives, the fight over how to deal with Surprise Medical Bills rages
fiercely on.
Take Big Bites out of OON Claims while the Debate Rages On
Out-of-Network claims, including surprise medical bills, don't have to be a huge
headache for payors or their plan enrollees. HHC Group has been reducing OON
claims and eliminating patient balance bills for over 23 years. Our bulldog attorney
negotiators are experts at getting providers to sign agreements accepting an
appropriate amount, usually much lower that the billed amount, as payment in
full. We also access our PPO network partners to take advantage of their deepest
discounts, while eliminating those costly balance bills.
'Rebate Trap' Keeping Generics Out of Reach
Hidden pacts with middlemen effectively block patients from having access to
cheaper generic medicines according to policy experts. Makers of established
brands are giving volume-based rebates to insurers or pharmacy benefit
managers (PBMs). In return these middlemen leave competing generics off
groups' formularies, costing employer and other groups and their employees and
members big bucks. They're also using other tricks to gain an advantage and stifle
Changing Definition of 'Employee" Impacting Insurance
The challenge in today's gig economy is how to determine who is an independent
contractor and who is an employee. With 40% of Americans working 2 jobs and 10%
building their careers entirely as independent contractors that determination is having
a greater impact than ever. The California Superior Court has ruled that the ABC test
be used instead of the Borello test, which has been the traditional test for making
the determination. Although the ruling is confined to California, it is having a ripple
effect across the country. In states switching to the ABC Test, companies' payrolls and
insurance costs are likely to skyrocket.
Three Star Preferred Provider Program Additions
Internal Medicine Associates SNF
Boca Raton, FL 33487

Dr. Jeffrey Farkas
Brooklyn, NY 1122

The Vison Connection
Bremerton, WA 98310

Pediatrix Medical Group
The Woodlands, TX 77380

IV Singh LLC
Grapevine, TX 76099

BJ Diagnostic Inc.
Aurora, IL 60502

The Psychiatry Group
Spokane, WA 99207