I owe what? Surprise medical billing and what to do about it
Release Date: 05/13/2019
Cousin Eddie on the COBRA doorstep: Do you really have to open the door?
ERISA is a friend of mine
In the larger scheme of corporate mergers and acquisitions, benefits issues are just nuisance issues ... until they're not. Buyers in stock and asset purchases are often stunned to learn that they may own COBRA liability related to the seller's former employees (and their dependents). And they might be required to open the doors of their group health plans to unwanted guests – the metaphorical Cousin Eddie – for up to 36 months. In this, the final substantive episode of the final season of ERISA is a Friend of Mine, Ed and Scott unravel the beguiling mysteries of COBRA (and health FSA)...
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Healthcare plan cost reporting: What’s hidden behind the wall
ERISA is a friend of mine
When a home’s circuitry goes bust, sometimes you have to rip into the walls to reveal the source of the problem. So too, with medical insurance. With the cost of medical care, and thus medical insurance, trending relentlessly higher, Congress decided it was time to bust into the walls to figure out why. Enter a new obligation on group plan sponsor: medical plan cost reporting. In this episode of ERISA is a Friend of Mine, Scott and Ed take a look at this new reporting obligation and the dazzling array of data the feds want plan sponsors to disclose, starting as early as this December. Tune...
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Medicare & COBRA: The most extreme of extreme sports
ERISA is a friend of mine
In the ERISA world, the collision of COBRA with Medicare is about as brutally taxing mentally as an ultramarathon is physically. Lucky for Ed and Scott, Courtenay Brummer from Lockton’s Mylo division joins the show to help us understand some of the convoluted nuances we encounter when COBRA and Medicare collide. In this episode, the trio work through: When does Medicare enrollment allow a plan to terminate COBRA? Why doesn’t Medicare enrollment, for an individual already buying COBRA coverage, operate as a second COBRA qualifying event? Where an employee enrolls in Medicare before...
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Why ERISA loves Betty Crocker: Nothing good happens without a recipe
ERISA is a friend of mine
If ERISA compliance were as easy as baking a cake, the establishment of a plan document would be an essential step in the recipe before it goes in the oven. Plan documents are critical to permit proper administration of the plan and, thusly, keep employers out of trouble. In this episode, Ed and Scott welcome back their colleague, and former Department of Labor national office attorney, Suzanne Bach, and address: What is a plan document and why is it important? Can a plan “document” be comprised of multiple documents? Can a plan document double as a summary plan...
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Lifestyle accounts for the not-so rich and famous: Nice perk, but watch your step
ERISA is a friend of mine
Lifestyle spending accounts, or LSAs, might be the new darling of employee benefit offerings, but this recent innovation is not without risk. Specifically, these employer-funded notional accounts, that can pay for everything from yoga classes to emergency car repairs, shouldn’t get too cozy with ERISA.
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Broker and consultant disclosures: How much do you make?
ERISA is a friend of mine
At the end of last year, Congress passed a piece of legislation that addressed, among other things, new broker and consultant disclosure requirements. The new obligations are focused on getting more detailed information in the hands of plan sponsors and fiduciaries.
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How long? ERISA, record retention and the end of reason
ERISA is a friend of mine
One of the most vexing aspects of benefit plan sponsorship and administration is hanging on to old records like enrollment forms, claim denials, plan documents, SPDs, ACA filings, etc. So when it comes to record retention, how long is long enough?
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Telemedicine: Every rose has its thorns
ERISA is a friend of mine
Telemed brings primary care and so much more, like substance use treatment and even physical therapy, into the virtual age. It offers unprecedented convenience to patients, lower overhead for providers and safety during a pandemic. But it's not all a bed of roses. In this episode, Scott and Ed discuss telemedicine's clinical and convenience advantages but warn about the compliance thorns that come with it.
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Mental health parity: We all need a helping hand
ERISA is a friend of mine
Federal regulators seem to have little hesitancy in asking employer group health plan sponsors to do the near impossible. The dream du jour requires employers to certify that their plans comply with mental health parity non-quantitative limitations (NQTLs). Rory Kane Akers, former DOL mental health parity auditor, joins the guys to break down what employers are required to do, why that’s nearly impossible, and best practices for leaning on carriers and TPAs to help.
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Dealing with the delta: Mandating and incentivizing the COVID-19 vaccine
ERISA is a friend of mine
With the COVID-19 delta variant on the rampage, a growing number of employers are using medical-plan related wellness programs to incentivize employees to get vaccinated. Ed and Scott outline the boxes an employer must check to promote vaccinations through a wellness program and Paula Day, Director of HR Compliance Consulting, drops by to discuss the similar boxes an employer must check when incentivizing vaccines outside of a wellness program.
info_outlineIn our last episode of season one, Ed jumps into the conversation a bit prematurely but that doesn’t stop Scott from giving him the business about surprise medical bills. Much to Ed’s dismay, he learns that apparently, whether or not you know how much your medical bill is going to be, you are still supposed to pay it.
- Why do patient’s get surprise medical bills? How do you get a surprise medical bill from an in-network facility?
- Is Scott’s life really a dystopian hellscape? And could exposure to it trigger Ed’s heart attack?
- What is balance billing? And how is it currently being addressed?
- How is the government getting involved? (Scott knows; he’s fancy.)
- Are any states addressing balance billing? What about Congress?
- Is baseball arbitration as painful as it sounds?
NOTE: Congress and the White House have continued to push solutions to surprise medical billing in between our taping and the release of our podcast. The White House held a press conference on the topic on May 9, 2019, and proposed legislation is expected before Memorial Day. We’ll provide an update in the show notes on specific policy proposals as they come available.