America's Benefit Specialist April 2023

PRICE-TRANSPARENCY ISSUES

By David Ostrowsky The Phia Group dostrowsky@phiagroup.com

When initiating last month’s SIIA Price Transparency Forum, Chris Condeluci (SIIA’s Washington counsel) and Ryan Work (senior vice president, government relations for SIIA) didn’t mince words when describing the dire state of American healthcare costs. The moderators predicted that if healthcare costs remain on this decades-long rising trajectory, one that has been exacerbated by Americans returning to their physi MANY OWNERS OF PROVIDER NETWORKS REFUSE TO SHARE PRICING AND CLAIMS DATA WITH PLAN SPONSORS AND, ULTIMATELY, THE PLAN MEMBERS.

cians en masse following the 2020 shutdowns, it could lead to the end of employer-based healthcare as we know it. The ensuing statistical presentation provided compel ling support for their argument. Out-of-pocket healthcare spending hasn’t grown at such a prodigious rate since 1985. The average premium for an employer-based family health care plan reached $22,221 in 2021—a staggering sum that amounts to approximately one-third of the median Ameri can household income and marks a threefold increase from 2001. Inflation is surely a factor, but not the primary culprit. Although there’s no silver bullet, the No Surprises Act (NSA), passed as part of the Consolidated Appropriations Act of 2021 (CAA) to safeguard patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, has moved the needle a tad in the right direction as evidenced by the prevention of 9 million surprise bills in the NSA’s first nine months of existence. But there have still been quite a few roadblocks, including a far greater number of out-of-net work payment disputes submitted compared to original

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