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Monday, 24 September 2018 15:05

The Fate of ACA Depends on a Texas Courtroom

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The partisan battle over the Affordable Care Act (ACA) heated up once again during the first week of September, when Judge Reed O’Connor in Fort Worth, Texas heard arguments from Republican attorneys general stating that the ACA is unconstitutional.  Although it may take a few weeks or even months for the judge to render his decision, the healthcare industry continues to speculate about the potential implications for the market, individuals, and employer group plans.  The crux of the issue is around the individual mandate and the preexisting condition protections that the ACA introduced.

The Medicare Part D Notice is just one of the many compliance responsibilities to which most employer health plans are subject. Since this notice is due in just a couple of weeks, continue reading for what you need to do.

We wrote a blog article in April about Consumerism and how to empower your employees to be smart consumers of health care. We know how difficult and confusing benefits can be, so check out these five additional tips to continue this education for your employees to enable them to advocate around their own health care and out-of-pocket expenses! 

Friday, 24 August 2018 10:30

Healthcare Claims Get Even More Confusing

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At Fall River we are committed to helping our members understand their health benefits and provider bills. We know that navigating the benefits world can be confusing, and unfortunately, we are seeing more and more claims situations that prove it’s getting ever more complicated. 

Here are recent examples of some complex and downright outrageous claims issues we want you and your members to be aware of.

Monday, 13 August 2018 09:25

The Battle to Cut Pharmacy Costs

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This past May, the Trump administration released its plans to reduce pharmaceutical prices on four fronts. The policy was laid out in a blueprint which describes the various fronts the Center for Medicare and Medicaid Services (CMS) and the department of Health and Human Services (HHS) propose to take to alleviate the problem. The four areas the administration proposes to target for action are increasing competition, better negotiation, creating lower list prices, and reducing patient Out-of-Pocket spending. Since all employer plans are impacted by the rising costs of prescriptions, we are encouraged to see active steps proposed to address the problem.

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