The Latest on Surprise Billing

An important part of the Consolidated Appropriations Act of 2021 is the No Surprises Act, intended to address surprise bills and protect healthcare consumers who receive a “balance bill” for amounts charged by a provider but not paid by their health plan. The law, scheduled to take effect on January 1, 2022, will protect patients that go to an out-of-network facility for emergency treatment, patients needing to be airlifted to the nearest emergency room by an out-of-network provider and patients receiving treatment from an out-of-network provider at an in-network facility.

The new law establishes uniform, basic federal requirements for insured and self-funded group health plans, however states may adopt even stricter standards for insurers and providers in their jurisdiction. To date, 17 states have adopted comprehensive balance bill laws to protect their residents. Guidance for several situations will need to be provided prior to year-end, including how plans will distinguish between in-network and out-of-network providers in self-funded plans using reference based pricing without a traditional PPO network. Industry sources expect these regulations to be issued by mid-year.

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Benefits Employees Want Most

benefitsThe pandemic has had an enormous impact on every aspect of our lives, including the way employees view employee benefits. A recent Wall Street Journal article chronicled the changing attitudes of workers who are working remotely or in hybrid settings. In virtually all cases, needs have shifted to things that contribute to employee well-being beyond the office.

Holistic Well-Being

When popular job search site Indeed surveyed 1,000 remote workers about the future of work, results made it clear that the need to support people’s mental and physical health outside of the workplace will continue long after the pandemic is over. Perks such as paid time off, flexible and remote working options and paid family leave are giving employees the support they need in a changing world. Depending on age and other workforce demographics, free therapy, personal financial planning advice and access to parenting coaches are doing a great deal to improve quality of life.

Changes to Family Leave

The International Foundation of Employee Benefit Plans reports that 63 percent of employers have made at least some change to their leave policies because of the pandemic. For employees who are also parents or caregivers, many have introduced emergency leave for childcare and eldercare. More than 10 percent are identifying resources and referrals for childcare, tutoring and backup or emergency child and eldercare with some providing financial assistance.

Companies are also supporting mental and physical health by instituting mandatory time off. Some do this by adding holidays or creating 4-day weekends while others have shut down for entire weeks because workers are unable to take customary vacations. Either way, employers and employees view these changes as some of the best things their companies could have done during the pandemic.

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New Ways to Benefit Mental Health

woman at desk

Many of us have read about actions some larger employers are taking to help employees struggling with psychologi- cal effects of Covid-19. Indications are that many small and mid-size organizations are taking positive steps as well. LinkedIn, a social media platform used by millions of businesses and individuals, is offering online courses to help employees address high levels of stress and fatigue. Meditation and how to deal with grief and loss are just two topics covered. A few regional banks are expanding telemedicine options to address some of the isolation experienced by those working at home.

Data compiled by the Centers for Disease Control and Prevention announced that in November of 2020, 42 percent of Americans reported symptoms of an anxiety or depressive disorder. While many employers plan to introduce programs supporting mental health, only about a third of employees surveyed in the PwC Workplace Pulse Survey said their employer was doing so.

The National Council for Behavioral Health’s Mental Health First Aid program offers a great deal of information and resources to help employers and individuals cope. To learn more, visit https://www.thenationalcouncil.org/covid19/.

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The E-Cigarette Epidemic

e-cigaretteIn 2016, ads for e-cigarettes reached almost 80 percent of middle and high school age students in our country. While advertising is not the only force influencing kids, a 2019 Youth Risk Behavior Survey of 4.9 million high school students showed that 6 percent reported smoking cigarettes and 33 percent used e-cigarettes in the past 30 days.

While regulatory agencies have been slow to react, pediatricians point out that nicotine forms addictive patterns in the brain that can last well into adulthood. The aerosols that get into the lungs from vaping lack thousands of carcinogenic substances contained in tobacco cigarettes, but they still contain formaldehyde and other harmful chemicals. And because adolescent brains are still developing, physicians believe that e-cigarettes can serve as a gateway to vaping of marijuana, which can impair memory, learning and decision making over time.

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Making Your Hotel Stay Safer

shiny hotel sign with starsBusiness and pleasure travel came to a serious halt in 2020, but industry representatives say bookings for later in 2021 are soaring. If you’re considering a hotel stay, a few questions suggested by the Infectious Diseases Society of America may be worth asking. For example…

  • Ask about current occupancy levels and limits the hotel or resort may have imposed.
  • What Covid-specific policies has the hotel or resort put in place?
  • Are face masks and social distancing measures required and enforced?
  • Are there limits on the number of guests allowed in the lobby and other public spaces?
  • How often are employees tested for the virus?

Finally, you may want to ask if the hotel’s HVAC system has hospital-quality filters and how long the hotel keeps a room empty between guest stays. Doing so for at least 24 hours is recommended as a way to clear the air of any aerosol transmissions. Other small measures to look for include sealed water glasses and strapped toilet seats in your room as well as self-parking, automated check-in and check-out, no-touch elevators and easily accessible staircases.

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The Value of Medication Adherence

Encouraging members and their dependents to take their prescriptions as directed by their doctor or pharmacist has long been a concern for health plans. As the Covid-19 pandemic continues to spike in most parts of the country, the problem has intensified, with experts estimating that the increased cost to our healthcare system may be nearly $300 billion annually.

Traditional challenges of rising costs and a failure to read and understand health information have been exacerbated by the fear of in-person doctor visits. Overcoming these issues requires increased communication and support because there is no doubt that when people fail to take their medications as prescribed, health plans often end up dealing with higher claim costs down the road.

A Higher Level of Support

Providing a high level of support can help many members avoid serious medical
complications in the future. Collaborating with a PBM or member advocate to send a
text message when a refill is due can be a big help. Some plans offer a lower copay as an
incentive to fill prescriptions on time.

Taking the time to understand a member’s needs and concerns can go a long way in
increasing medication adherence. While concerns about using generic alternatives,
copay assistance programs and transportation are common, addressing language barriers,
disabilities and other social factors are measures that can make a big difference.
Providing a higher level of support will not only produce higher quality outcomes, but
lower pharmacy benefit costs as well.

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New Rules for Drug Pricing

drug-pricingTwo final rules related to the President’s promise to lower the cost of prescription drugs were recently announced by President Donald Trump. The first, known as the “most favored nation” rule, would lower the price of 50 Medicare Part B drugs to those paid by other wealthy countries. This pricing would apply only to Medicare beneficiaries. The second rule, intended to simplify drug pricing and pass available discounts to consumers, would eliminate the rebates drug manufacturers currently pay to Pharmacy Benefit Managers (PBMs) on higher priced brand name prescription drugs. Interestingly, in another recent action, drug manufacturers filed a lawsuit to stop the Trump administration from allowing states to import certain prescription drugs. Their suits argue that the last-minute steps by the President would expose the public to safety risks while not achieving any significant economic advantages for the public.

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Technology and Diabetes Care

diabetesAs COVID-19 has made medical office visits challenging, CDC has recommended digital diabetes care supported by connected continuous glucose monitoring (CGM) systems. According to CDC, when remote monitoring is combined with proper medication adherence and personalized coaching, employees with diabetes are able to receive the constant, long-term oversight needed to maintain a higher quality lifestyle.

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Working Remote = Working More

remote-workingAccording to a video conferencing company, employees working remotely have been logging about one extra day a week as the lines between work and home continue to blur. While some have saved commuting time, others are simply extending their workday. Despite some challenges, many people are enjoying greater flexibility and feeling just as productive when working remotely.

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Lowering Stress Takes Creativity

You don’t have to dig very deep to discover higher stress levels due to the pandemic. To combat the problem, many companies are taking creative steps to help employees relax. While some are providing a free day each quarter, others are doing it monthly. From “you days” to “disconnect and recharge” days, these are must-take days where everyone is free to enjoy a break without feeling guilty or worrying about what they may be missing.

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