The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors
Physicians generally do not have direct standing to bring a claim for benefits under an ERISA group health plan. Rather, a physician’s standing derives from the patient’s status as a plan participant and must be assigned....more
Earlier this month, a Mayo Clinic employee filed a proposed class action against the clinic, arguing that the clinic’s employee health plan and its third-party administrator (TPA) Medica, underpaid for services performed by...more
Benefits costs continue to increase globally, and in the midst of high inflation and potentially a recession, executives are exploring cost effective methods to manage their self-insured health plans without compromising the...more
If you work for or represent group health plans or issuers of group health plans, it is important that you take a look at the contracts they have with health care providers before the end of 2023. The Internal Revenue Code...more
The myriad health and welfare plan requirements in the Consolidated Appropriations Act, 2021 include those for a group or individual health plan to maintain a cost comparison tool and an accurate and up-to-date network...more
The move by some employer plans to a “reference-based” pricing model has created a need for healthcare providers to develop a strategy to confront payment challenges that these plans create. A prevalent model of...more
On November 15, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (collectively, the “Agencies”) issued a proposed "Transparency in Coverage" rule that would require most...more
Health and Welfare Plan Update - It is 9:00 p.m., do you know where your health plan data is? As IT systems continue to expand, and data is accessed, moved and stored in many new and different ways, the Office for Civil...more
This is the first episode in K&L Gates’ three-part series on the 340B Program with Chris Hatwig, President of Apexus, LLC. Apexus serves as HRSA’s Prime Vendor in administering the 340B Program, including by publishing...more