Why Most Employers Fail at Health Plan Compliance with Jennifer Stanley

Specifically, I want to talk about the No Surprises Act.

And what does an employer who's on top of it have in place that others miss?

That's a unicorn.

There's not an employer on top of this.

They're all missing it.

And it's unfortunately the No Surprises Act.

So in 2020, December 2020, you had the CAA of 2021.

And that had kind of this like bifurcated type or two titles of impacting our world.

So the first one.

was the no surprises act and that is for the consumer great that's where they try to put all the information on your little id card no balance billing consumer shopping tools price transparency all these great things so from a consumer side wonderful on the employer plan sponsor pay your side it's It's a disaster.

And employers don't even know that it's a disaster.

They don't even know this is happening.

Who does know it's happening? Providers and their entrepreneurs who saw a need and came and filled it and, frankly, have taken advantage of it to the detriment of the plan sponsors and of the cost.

So what's supposed to happen is if there is a dispute or a balance bill, right, you can't bill the consumer anymore.

You can't bill the participant.

on air ambulance or out of network providers that are in network facility and emergency room things.

Those can't be balanced bill to the consumer.

Stuff is not free, right? Somebody's got to pay for it.

And who's paying for it? Well, the employer.

And a little bit, very little bit of the participants.

And so there's supposed to be this good faith negotiation process that happens and that gets skipped.

The providers have engaged, you know, their problem solvers.

I'm making a shit ton of money.

Probably can't say that again, but they are.

And they are flooding the federal system for these dispute resolutions.