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Reference-based pricing plans (RBPs) impact costs by paying healthcare facilities – that’s to say hospital outpatient facilities, and ambulatory surgical centers – a percentage over the amount that Medicare would pay for the same service. This practice contrasts the reimbursement methodology the traditional insurers use, which is a discount off of the facilities’ billed charges. The result is that payments to facilities are much lower than traditional insurers pay. Employers realize these savings because the self-funded financing model passes those along directly to them. Viewpoints from Matthew Presutti I spend a lot of time debating the state of affairs …

… longer be available. But that may be it legislatively until 2021. It’s clear that both parties are happy with giving voters universal good news. But the kind of changes that make a real impact will change the equilibrium. With the required pay-for, it will be tough in this election year to address the biggest concern of the average American: worsening benefits resulting in higher out-of-pocket costs. I read a recent report by the Agency for Healthcare Research and Quality (AHRQ) on how higher deductibles are impacting families, with out-of-pocket costs for maternity skyrocketing. While

With the rising popularity of high deductible plans, understanding Health Savings Accounts (HSAs) has become an important component of financial management. HSAs offer triple tax benefits: tax-free accumulation, tax-free earnings, and tax-free distribution if you follow the rules. Distributions made prior to age 65 are subject to a 20% penalty and current income tax but those age 65 and over can withdraw freely from their HSA and only pay current tax. This is similar to a 401(k) or other pension plan except deposits are not subject to Federal Insurance Contributions Act (FICA) taxes. Viewpoints from Craig …

… protections in place against surprise balance billing, these are limited by federal law. Most of our clients don’t have an issue finding in-network care but it has the potential to be very problematic if gone unaddressed. Typically, alternative arrangements can be made when an in-network provider is not available to an employee, and their provider will be treated as in-network for a service or series of treatments. This applies if the employee truly cannot find a provider – not that they just don’t like any of the in-network choices in their area. Often, the insurance