Given recent increased litigation and its impact on the regulatory environment, benefits consultants and plan sponsors should rethink their past decisions to simply comply with the No Surprises Act (NSA).
It's time to rethink our initial approaches to compliance, which have added to the cost of coverage in advance of almost perennial plan sponsor annual enrollment activity such as:
- Bidding out the coverage
- Increasing employer and worker contributions
- Increasing point of purchase cost sharing
- Limiting the provider network
- Some combination of those or other actions
It's time instead for brokers and advisors to challenge third-party administrators (TPAs) of self-insured plans to tease out the NSA claims experience by identifying claims where the qualified payment amount (QPA) was applied, where expenses were processed in-network versus out of network, and where it triggered a challenge using the independent dispute resolution (IDR) process.
Today's preferred provider organization (PPO) networks are comparable to a river that is a mile wide, with price discounts that are less than an inch deep. It's also time for brokers and advisors to identify changes in the provider network and determine to what extent has the NSA prompted provider consolidation. That is, who shifted from out-of-network (OON) to in-network? Further, in plans that use the typical PPO design of higher OON cost sharing, has network expansion reduced the cost-sharing differential used to justify lower point of purchase cost sharing for network providers? We believe such analysis will show, sooner or later, greater network participation, consolidation of providers, resulting in ever-increasing disputes in fee negotiations between provider networks and insurers.
Continue Reading for Free
Register and gain access to:
- Breaking benefits news and analysis, on-site and via our newsletters and custom alerts
- Educational webcasts, white papers, and ebooks from industry thought leaders
- Critical converage of the property casualty insurance and financial advisory markets on our other ALM sites, PropertyCasualty360 and ThinkAdvisor
Already have an account? Sign In Now
© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
