Adam V. Russo | May 27, 2009
Doctors protested self-insured Georgia-Pacific’s attempt to collect refunds of suspected claims upcoding.
by Emily Berry of American Medical News, www.amednews.com
Following an outcry from physicians and discussions with the Medical Assn. of Georgia, one of Atlanta’s largest employers has temporarily halted work by a company it hired to seek supposed overpayments from doctors. (more…)
Adam V. Russo | April 9, 2009
The 2008 Employee Benefits study by the U.S. Chamber of Commerce found that small businesses saw the cost of providing certain benefits rise from 2006 to 2007. Health insurance costs rose 15%, averaging $4,559 per employee in 2007 from $3,961 in 2006. The report showed that employers began scaling back on employee benefits as the economy slowed down in 2007. The average dollar amount of employee benefits fell 14% to $18,496 in 2007 from $21,527 the year before.
Adam V. Russo | March 23, 2009
by Dave Lenckus of Business Insurance
While third-party administrators can deliver efficiencies for self-insured programs, risk managers should require protections and maintain vigilant oversight for instances when the claims process breaks down, risks managers say.
If “properly vetted,” a TPA can provide great service and “enhance metrics and decision making” said Wayne L. Salen, director of risk management for Labor Finders International Inc, In Palm Beach Gardens, Fla. (more…)
Adam V. Russo | March 3, 2009
by Ron E. Peck, Esq.
As you can imagine, some optional benefits are being eliminated and other benefits – once thought of as concrete – are being made voluntary. That means beneficiaries must choose whether to go without a benefit, or pay for it themselves. (more…)
Adam V. Russo | September 30, 2008
While health care costs increases continue to far outpace inflation, costs are rising at a far more moderate pace than a few years ago, according to two surveys released last week.
The surveys-one by the Washington-based Kaiser Family Foundation and Chicago-based Health Research & Educational Trust, and the other by Stamford, Conn.-based benefit consultant Towers Perrin-also show that employers are turning more to consumer-driven health plans to help control costs. (more…)
Adam V. Russo | September 5, 2008
The Supreme Court held in MetLife vs. Glenn that conflicted interests require a higher standard of review whenever the claims adjudicator and the claims financier were the same. Thus, any claim contested in court will confer a significant advantage to the arrangement where the claims are adjudicated by an independent third party and paid by an independent employer. This means a disadvantage where the claims are both adjudicated and paid by the same two parties, such as employer’s self-administered and self-funded plan or fully insured plans. (more…)
Adam V. Russo | July 7, 2008
by Ron E. Peck, Esq.
The matter of administrative discretionary authority, when administering a health benefits plan within the purview of ERISA, and the deference federal courts must show to such discretion, has been the new hot topic in ERISA ever since subrogation rights were affirmed by the Sereboff case. The Supreme Court first stated that health plan administrators, who assert discretionary authority to administer a plan within the plan’s document, are due deference in Firestone Tire and Rubber Co. v. Bruch. Afterward, federal courts could overturn administrator benefit determinations only if they find that the administrator has abused its discretion (an arbitrary and capricious standard of review). (more…)
