Vanner’s Perspective

Healthcare Wars: Employers Caught in the Middle

As the political battles – and stalemate - over the Affordable Care Act continues, employers may find themselves with the worst of all worlds. The portions of the ACA that create the greatest burdens on employers, such as the mandates, taxes and administrative obligations under the ACA stay, in place. At the same time, uncertainty in the individual markets creates blowback that hurts employers in a number of ways.

By | October 4th, 2017|Tags: , , , , |

Do What You Say You Are Going to Do

Two recent cases illustrate the risks of allowing plan practices to diverge from plan documents. In one case, Acosta v. Macy’s, the Department of Labor has brought a lawsuit against Macy’s department store for (among other things) changing the payment methodology for calculating out-of-network claims without appropriately modifying the Macy’s plan document. In the other case, Erwood v. Life Ins. Company of North America, an administrator’s failure to follow documented plan procedures triggered a $750,000 judgment. Both of these cases highlight how easy it is to overlook the fundamental ERISA responsibility of ensuring that plan administration syncs up with the plan documentation. And, both of these cases highlight the risks posed by such failure.

By | September 18th, 2017|Tags: , , , |

The Down-streaming of Health Care

In addition to the opportunities for policymakers to actually reduce rather than merely shift health care costs noted in  Don’t Confuse Cost Shifting with Cost Savings  (such as bundled payments for certain episodes of care and value-based […]

By | September 9th, 2017|Tags: , , , |

Large Numbers, Risk Pooling and Adverse Selection

As legislators continue to repeal and replace the ACA, they look for new ways to separate portions the insurance markets into different segments. Some efforts counter actuarial and insurance principles: segmenting the risk pool increases volatility and that creation of different risk pools based on health status and effect premiums

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