July 2019 Volume 21 Issue 7
Providing Current Information on

Health Insurance Industry Issues and Legislation

Patient Out-of-Pocket Costs Up Sharply Again
Patient out-of-pocket (OOP) costs continue to skyrocket. Patient OOP
responsibility for inpatient, outpatient and emergency department visits rose
12% in 2018. The largest increases were for inpatient (+14.5%) and outpatient
(+12.0%) care. Patient OOP cost for emergency department care grew more
slowly (+6.9), as many people chose more cost effective settings for care when
possible. Disturbingly, the percentage of patients paying $501-$1,000 per hospital
visit jumped from 39% in 2017 to 59% in 2018 while patients paying $500 or less
dropped from 49% to 36%.
Driving Down Group and Patient Costs
One way to help control healthcare costs is to make sure the payers and their
employees/members pay only an appropriate amount for the services provided.
HHC Group utilizes negotiation of in and out-of-network claims, discounts from
Preferred Provider Networks for out-of-network claims, Medical Bill Reviews to
eliminate errors on claims and DRG Validation to ensure claims are coded correctly,
to minimize payers and employees/members costs.
Estimated 2020 Employer Medical Costs
Private employer medical costs are projected to increase by 6% in 2020, in spite of
employers efforts to cut costs, according to PwC's Health Research Institute's annual
medical cost trend survey. Higher prices for medical services, prescription drugs,
treatment of chronic diseases and more employees accessing metal health services
will all contribute to the increase. Utilization is actually projected to decrease,
probably as a result of high deductibles.
Section 1557 Rule Change Would Impact Self-Funded Plans
The U.S. Department of Health and Human Services (HHS) has issued a proposed
rule that would repeal and replace major portions of the Section that deal with the
definition of discrimination "on the basis of sex" including discrimination based
"gender identity" and "termination of pregnancy". If the rule goes into effect it
would make Section 1557 inapplicable for most self-funded and fully insured group
health plans.
Three Star Preferred Provider Program Additions
Lehigh Regional Medical Center
Lehigh Acres, FL 33936

Allergy and Asthma Physician of
Commerce Township
Birmingham, MI 48012

Orthofix Inc.
Dallas, TX 75284

Norwalk Cardiac Thoracic
Norwalk, OH 44857

Dr. Garcia and Associates
Mishawaka, IN 46545

Neurology Center of North Florida
Lake City, FL 32025