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for: ‘Group Health’

COBRA Coverage

Existence of COBRA coverage, with all of its deadlines and mind-numbing rules, creates headaches for providers, but managed effectively, also provides reimbursement unavailable without the coverage. Plans required to offer COBRA also see it as a headache, but for the opposite reasons. Plans want to avoid extra reimbursement and they adroitly use the complex laws …

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Medicare Secondary Payer

Despite the longstanding prohibition against such activity, Group Health Plan’s (GHPs) continue to search for ways to take Medicare into account, denying plan member’s benefits to which they are entitled and leaving the federal government to pay for treatment cost the GHPs are required to cover. The Gibson Firm has encountered two main trends in …

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Repricers and “Cost Containment” Solutions

In 2010, we saw an explosion in the number of benefit plans employing repricers and ―cost containment‖ companies. Typically, these companies offer to review charges submitted by providers and reduce the charge to a “reasonable’ amount under the auspices of “usual and customary” reimbursement. In exchange, the repricer is usually paid a percentage of the …

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