Core and Group Health

The federal No Surprises Act now requires health care providers and health insurers like Georgia Blue to take disputes over some out-of-network claims for insured patients to "independent dispute resolution" services rather than sending big bills to the patients.

Employer plans that make participants try preferred drugs first would have to allow for appeals and exceptions.

Increased security on pharmacy benefit managers (PBMs) as well as state and federal action to rein in their influence could have impacts across a variety of stakeholders in the health care system, including patients, PBMs, pharmacies, health care plans and manufacturers.

Two compliance experts share their thoughts on the impacts of the "One Big Beautiful Bill Act."

Insurers must spend 80% of total premiums and 85% of money from premium increases on health care.

The "Informed Choice" program may cut costs for patients who see doctors with high quality and affordability scores.