Author Archive: Madeline O'Brien

As Ground Ambulance Committee Begins Its Work, New Report on Balance Billing by Ground Ambulance Providers Highlights a Gap in the No Surprises Act

On December 9, the Centers for Medicare and Medicaid Services announced the membership of the Advisory Committee on Ground Ambulance and Patient Billing, as required by the No Surprises Act (NSA). As the committee prepares to begin its work, there is new evidence out of Texas that the NSA’s exclusion of ground ambulance bills puts consumers at a significant financial risk when they need emergency medical transport.

CHIR Interactive Map Highlights New Details on No Surprises Act Enforcement

The No Surprises Act (NSA) went into effect this year, providing new protections against surprise medical bills for patients who receive unanticipated out-of-network care. CHIR has analyzed state NSA implementation and enforcement schemes and published an interactive map for the Commonwealth Fund, providing details about policies such as state enforcement strategies and patient-provider dispute resolution. In the newest iteration of the map, CHIR added updates on state payment determination mechanisms and protections against surprise ground ambulance bills.

Response to Deceptive Marketing of Limited Plans Shows States Can Take Proactive Steps to Protect Consumers

Last month the Texas Department of Insurance issued a consent order dissolving Texas-based Triada Assurance Holdings, operating under the name Salvasen Health, which marketed and sold their fixed indemnity plans to 65,000 consumers nationwide, advertising their products as comprehensive coverage. CHIR’s Madeline O’Brien looks at is Salvasen’s deceptive practices and state responses to mitigate harm to consumers.

PrEP Coverage Obstacles Highlight Challenges Implementing the ACA Preventive Services Requirement

The ACA requires coverage of recommended preventive services without cost-sharing for consumers enrolled in most private health plans. But even with these protections in place, some insurers improperly impose cost sharing for preventive services. Recently, this problem hit consumers who use pre-exposure prophylaxis (PrEP), a medication that can prevent contraction of HIV.

Parity in Practice? Examining Requirements and Enforcement of the Mental Health Parity and Addiction Equity Act

Last fall, the Pennsylvania Department of Insurance documented that the UnitedHealthcare Insurance Company had committed several violations of the Mental Health Parity and Addiction Equity Act (MHPAEA). Other states are also increasing their oversight efforts. However, over ten years after the law was enacted, federal and state insurance regulators are still working to insure consumers have the protections promised under the law. CHIR’s Madeline O’Brien explains what MHPAEA is, how it is enforced, and recent CHIR efforts to support effective oversight.

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.