New Resource for Consumer Advocates on Out-of-Network Payment Disputes in Balance Billing Legislation

State lawmakers across the country are are gearing up for a new legislative session. Many will be considering state-level protections for consumers to prevent surprise out-of-network medical bills. Just as with the federal legislation, however, one of the key sticking points for state policymakers will be how to approach out-of-network provider reimbursement. To aid stakeholders in these efforts, Community Catalyst teamed up with CHIR experts to create a guide for its health insurance reform toolkit: The Advocate’s Guide to Addressing Out-Of-Network Payment in Surprise Balance Billing Legislation. Continue reading

Protecting Patients from Air Ambulance Surprise Balance Bills – Where Are We Now?

A recently released report by the Health Care Cost Institute finds that the average price of an air ambulance trip has increased significantly from 2008 to 2017, a Department of Transportation advisory commission is studying the industry’s billing practices, and legislation is pending in Congress to protect patients from surprise bills sent by air ambulance companies. CHIR’s Maanasa Kona and Sabrina Corlette provide an update on the recent activity. Continue reading

Can States Fill the Gap if the Federal Courts Overturn Preexisting Condition Protections?

The 5th Circuit Court of Appeals is expected to rule soon on the future of the Affordable Care Act in the Texas v. U.S. case. In their latest post for the Commonwealth Fund’s To The Point blog, CHIR’s Sabrina Corlette and Emily Curran evaluate whether states can protect their residents from the fallout, particularly for those with pre-existing conditions, and provide an update on the latest state efforts. Continue reading

Will Sutter Health Settlement Dampen Provider Systems’ Anti-Competitive Tactics or Prompt More States to Take Action on Costs?

On October 16, Sutter Health announced that it had reached a tentative agreement to settle the class-action lawsuit against it, which alleged that the system has used its market dominance to drive up the cost of care. Though Sutter Health denied all allegations, the plaintiffs argued that the system relies on three core tactics to maintain a competitive edge, including: all-or-nothing contracting, anti-incentive contract terms, and price secrecy contract terms. CHIR’s Emily Curran and Sabrina Corlette explain these tactics and recent findings on the impacts of provider consolidation. Continue reading

Seeing Fraud and Misleading Marketing, States Warn Consumers About Alternative Health Insurance Products

States are warning consumers of fraud and about the inadequate nature of some insurance products being sold that masquerade as health coverage. Over the last year, we identified alerts or press releases issued by 15 states warning consumers to be on their guard against deceptive marketing pitches for these products. In their latest post for the Commonwealth Fund’s To The Point blog, CHIR experts spoke with regulators in five of these states to better understand what was behind these warnings and get insight into potential pitfalls for consumers. Continue reading

New Georgetown CHIR Report Finds Ability of Insurers, Employers to Respond to Provider Consolidation is Limited

A new Georgetown CHIR report synthesizing the case studies of 6 health care markets finds that insurers and employer-purchasers have limited tools and incentives to effectively counter the market clout of increasingly consolidated provider systems. With a lack of market-based solutions, the report raises questions about whether and what policy interventions might be needed. Continue reading

New Georgetown CHIR Report: In Trump Era, States Revisit the Benefits and Risks of Running Their Own Health Care Marketplace

Half a dozen states have announced they will transition from HealthCare.gov to their own, state-run health insurance marketplaces. In a new report with the Urban Institute, CHIR researchers assess states’ reasons for making the switch, risks and benefits, and considerations for policymakers in other states contemplating a similar move. Continue reading