Author Archives: Reeve Conover

Surprise out of network bills

Out-of-network healthcare can be costly and is often something patients try to avoid. But when an emergency occurs, a visit to an in-network hospital can still result in an unpleasant surprise — a highly expensive medical bill because the patient was treated by an out-of-network physician.

Surprise billing and related costs are increasing among inpatient admissions and emergency department visits to in-network hospitals. From 2010 through 2016, 39% of more than 13 million trips to the emergency department at an in-network hospital by privately insured patients resulted in an out-of-network bill, a new study published by medical journal JAMA Internal Medicine finds.

“This is becoming a bigger and bigger issue,” says Kim Buckey, president of client services at DirectPath. “We’ll probably see more employers working at state and federal level to put some pressure on their representatives to do something about this. They’re paying their share of these higher out-of-network costs and it’s hitting their bottom lines as well as their employees.”

ACA penalty letters for businesses

Affordable Care Act Penalty letters are making the rounds once again. The IRS is sending out new Penalty letters, this time for 2017 enforcement of the Affordable Care Act.  In addition to assessing penalties for not offering coverage or if employees went to the exchange and received subsidies, they are now also sending out penalty assessments, enforcing the rules for Timely and Accurate Filing for the required Employer filings.  These are referred to as IRS Letter 972CG penalty letters.  These penalties are if the filings were not submitted on time or if the employer was large enough , they had to submit electronically to the IRS.  They are also cross referencing corporate tax returns to see if there are control groups who would be considered 1 employer under the ACA and did not complete filings or did not provide proper coverage to employees which would trigger Penalty A or B of the Affordable Care Act for Employers.  I attached an actual letter a client has received, dated 8/5/19.

We have seen employers in New York, Pa, Tx and Illinois receive penalty letters recently in the past week or so.

Another 401k hit with excessive fee judgement

This is one of the reasons we benchmark fees and monitor quarterly.

“The suit claims that, for every year between 2013 and 2017 (the same time period in the Adidas case), the administrative fees charged to plan participants was “greater than 90 percent of its comparator fees when fees are calculated as cost per participant or when fees are calculated as a percent of total assets,” and that “the total difference from 2013 to 2017 between TriHealth’s fees and the average of its comparators based on total number of participants is $7,001,443.” Moreover, they claim that the total difference from 2013 to 2017 between TriHealth’s fees and the average of its comparators based on plan asset size is $7,210,002, and that the TriHealth plan charged 401(k) fees of $328 per person in 2017, when similarly sized plans – those with between $250 million and $500 million in assets – charged an average of only $166 per person that year.

At least part of that differential was attributed to the choice of actively managed funds. The plaintiffs note that, “by selecting and retaining the Plan’s excessive cost investments while failing to adequately investigate the use of superior, lower-cost mutual funds from other fund companies that were readily available to the Plan or foregoing those alternatives without any prudent reason for doing so, TriHealth caused Plan participants to lose millions of dollars of their retirement savings through excessive fees.”

For the full Article click here.

South Carolina Blues switch to Optum

Beginning Jan. 1, 2020, BlueCross BlueShield of South Carolina‘s pharmacy benefit will be administered by OptumRx.

There will be little or no effect on most members from this change. However, there are a few updates to BlueCross’ prescription drug coverage for 2020:

  •  ID Cards: All members will receive a new ID card in December to replace their current one. Members should be sure to show their new card at the pharmacy when they have their first prescription filled in 2020. Members can always access the most up-to-date version of their ID card by logging in to My Health Toolkit (on the web or via the app).
  •  Mail-Service Pharmacy: Beginning Jan. 1, mail-service will be provided by OptumRx Home Delivery. Most current mail-service prescriptions will automatically transfer. Members with mail-service prescriptions will receive a letter from BlueCross in November with more information.  
  • Specialty Pharmacy: Also beginning Jan. 1, BriovaRx will be BlueCross’ new preferred specialty pharmacy. Members who currently use a specialty drug purchased through CVS Specialty Pharmacy will have their prescription automatically transfer to the new specialty pharmacy. All members affected by this change will receive a letter from BlueCross in mid-November with more information. 

 As part of their health plan’s regular pharmacy benefit updates, some members may also experience changes to their prescription drug coverage on Jan. 1, 2020. Any member, who is currently taking a drug that will be affected by changes taking effect on Jan. 1, will be sent a letter in mid-October describing the change and any actions needed.

Future 2- Do your own blood test!

LabCorp, one of the largest clinical laboratory companies in the world, is now giving consumers the option to order their own blood tests online as it positions itself for a major expansion of brick-and-mortar testing sites in Walgreens stores.   

The company announced the new offering July 22 as an expansion of its “Pixel” platform. Pixel was launched last October with self-directed test kits, which allow people to screen themselves at home for colorectal cancer, diabetes risk and lipid panels.  

LabCorp’s newest offering allows consumers to go online and choose from 25 different test packages, which collectively cover 90 different lab tests. Test packages are targeted at various systems like thyroid health, kidney health and women’s health. After consumers buy a package, they can visit a LabCorp location for a phlebotomist to collect a blood sample, and they then receive test results within a week through an online portal. LabCorp operates testing sites at 41 Walgreens stores and plans to expand to more than 600 Walgreens locations by 2022. LabCorp currently has a total of nearly 2,000 patient service sites.

Want to know how much? Click here for the article.

Blog Archives

Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck