Podcasts about no surprises act

The FTC just notched its second win against the biggest roll-up in anesthesia history. Welsh Carson settled first. Now USAP. So who actually won, and who pays next? Joe Rodriguez sits down with Randy Moore and Gary Keeling for the kind of conversation that usually happens at the bar after the conference, not on the record. No "where did you go to school" warm-ups. Just three operators reading the headlines everyone else is misreading. Gary drops the frame that defines the episode: this is two Goliaths at war. Private equity built 70 percent market share with borrowed money. Insurers answered with the No Surprises Act and rate cuts. Now IDR is swinging back, hospitals are eating the shortfall through subsidies, and the FTC just stepped into the ring. Anesthesia providers are standing in the middle of all of it. Then the gloves come off on the anesthesiologist assistant fight. Sixty bills in thirty years. Gary says there's enough work for everybody and braces for the hate mail. Randy makes the case that should worry every workforce planner in the country: this shortage isn't a cycle anymore, it's structural, and it's not normalizing for five to seven years. Joe closes with the contrarian bet he's making with his own money. If you book the cases, staff the rooms, or sign the subsidy checks, this episode is your briefing. Takeaways The FTC win is a settlement, not a verdict. USAP admitted no fault and the terms are still being executed. The real signal is that the roll-up playbook now carries regulatory risk that didn't exist a decade ago. The Goliath framework: insurers wanted fragmented anesthesia markets they could play against each other. PE consolidated to fight back. The NSA flipped leverage to insurers, IDR is flipping it back, and hospitals absorb every swing through subsidies. PE's debt structure is the tell. Buy with borrowed money, load the debt onto the asset, run admin on a skeleton crew, jettison through bankruptcy when it breaks. Margin expectations beyond 6 to 15 percent in a service business are the warning sign. AA legislation has a 30-year losing record. Roughly 60 attempts, 47 straight failures from 2010 to 2019, and only 5 of 40 passed in 2025 during a historic shortage. If it was going to break through, that was the year. Randy's call: the workforce shortage is structural, not cyclical. Every CRNA program is expanding cohorts and demand still outruns supply. No meaningful normalization for five to seven years. The pipeline counterweight: 147 nurse anesthesia programs with 17 more coming. Joe's on the record preparing for demand growth to slow. Cycles always turn. Gary's operator test: the 2 percent of groups with excess staff aren't lucky, they built culture and systems. Everyone else is churning providers and renting locums at whatever price locums name. Want more Dr. Joe Rodriguez? Tik Tok: @jrodcrna21 Instagram: @jrod.crna & @abouttherestpod YouTube: @AboutTheRest Thanks for my co-hosts: Randall Mooore, DNP, MBA CRNA are Executive VP of Strategy and Chief Anesthetist Officer, former AANA CEO. Gary's is VP of Anesthesia Services, Revenue Cycle Management To Learn More about Human Content Visit: ⁠⁠⁠http://www.human-content.com⁠⁠⁠ To Learn More about About The Rest Visit: www.abouttherest.com Got a Question? hello@abouttherest.com Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

A shift is happening in the skies right now, as airlines quietly slash schedules and strip away basic comforts taken for granted for decades. If you don't double check your bookings, you could be walking blindly into a canceled itinerary—or a "bare-bones" cabin with zero food or water. Meanwhile, a strange new industry experiment means the ticket you bought for a connecting flight may turn out to be for an unforeseen road trip instead. Clark explains. Shifting to the housing market, if you're looking to purchase your first home, Clark has a strict warning: Wait. It is a historically bad time to buy your first house in most of America, and doing so right now is essentially stepping into a financial trap. Plus, Christa shares your #AskClark questions and Clark gives his take. All this and more on the June 15, 2026, episode of The Clark Howard Show.  Submit your questions: Ask Clark. Air Travel: Segment 1 Ask Clark: Segment 2 1st Time Home Buyers: Segment 3 Ask Clark: Segment 4 Mentioned on the show: Zero Service: Delta Air Lines To Remove Main Cabin Drinks & Snacks On 450 Flights Delta's Popular Short-Haul Perk is Going Away — Here's Why [The Washington Post] Airlines surprise passengers with ‘flights' that are buses It's a historically bad time to buy your first home  20 major housing markets with enough inventory to create homebuyer deals later this year Surprise medical bills and the No Surprises Act 6 Things To Know Before Contacting the National Foundation for Credit Counseling Clark.com resources: Episode transcripts Community.Clark.com  /  Ask Clark Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices. Visit megaphone.fm/adchoices

The No Surprises Act was designed to protect patients from unexpected medical bills, but nearly four years after the law took effect, many experts say parts of its implementation aren't working as intended. Insurers, hospitals, physician groups and federal regulators continue to battle over the law's payment dispute process, raising questions about whether one of the nation's most significant health care consumer protection laws is achieving its goals.In this special live episode of Tradeoffs, host Dan Gorenstein moderates a conversation with three leading experts on surprise medical billing, health insurance regulation and federal health policy. They explain how the No Surprises Act was implemented, how litigation has shaped the arbitration process, why providers have won a disproportionate share of payment disputes and what policymakers could do to improve the law.Guests:Zack Cooper, Associate Professor of Public Health and of Economics, Yale University; Director of Health Policy, Tobin Center for Economic Policy; Director, Health Care Affordability Lab at YaleBenjamin Chartock, Assistant Professor of Economics, Bentley UniversityLindsey Murtagh, Senior Fellow in Health Services, Policy and Practice, Brown University School of Public HealthRachel Werner, Executive Director, Leonard Davis Institute of Health Economics; Professor of Medicine, Perelman School of Medicine, University of PennsylvaniaLearn more: Read the full reporting and explore additional resources on our website.Want more Tradeoffs? Join more than 5,500 readers who trust Tradeoffs for clear, deeply reported health policy insights. Sign up for our free weekly newsletter.Tradeoffs helps you cut through the noise with clear, deeply reported journalism on the forces driving health care's toughest choices — reporting you won't find anywhere else. If our work helps you stay informed, support it with a donation today. Hosted on Acast. See acast.com/privacy for more information.

This Day in Legal History: Rhode Island Ratifies the Constitution, 1790On this day in 1790, Rhode Island became the thirteenth and final original state to ratify the United States Constitution, doing so by a margin of 34 to 32 at a convention in Newport. Rhode Island's hesitation had been considerable: the state refused to send delegates to the Philadelphia Convention in 1787, and twice rejected ratification in popular referenda — a curiously democratic method for refusing to join a constitutional union founded in part on the premise that pure direct democracy is dangerous. The state's small-farmer and debtor classes, the same constituencies that had backed the paper-money policies that horrified Madison, were deeply suspicious of a strong federal government that would constrain state-issued currency, ban impairment of debt contracts (Article I, Section 10), and override state-level debtor protections.Ratification finally came under the gun: Congress, frustrated by the foot-dragging, was openly threatening to treat Rhode Island as a foreign nation for tariff purposes, which would have devastated the Providence merchants. The convention's narrow margin reflected a hostile deal more than a meeting of constitutional minds.Importantly, Rhode Island's ratification was conditioned on a lengthy list of proposed amendments — many of them mirroring the Bill of Rights that James Madison had already shepherded through Congress in September 1789 and that would be ratified in December 1791. With Rhode Island in, the original Union was at last complete, and the practical question of whether the new federal government could function with one stubborn holdout fell away. The episode is a useful reminder that the constitutional founding was not so much a singular moment as a slow, contested, occasionally coerced bargain — one that ended in Newport on a humid Saturday in May.The U.S. Supreme Court on Thursday handed down a narrow 5-4 ruling in Pitchford v. Cain, reviving a Mississippi death row inmate's challenge to the prosecutor's race-based use of peremptory strikes at his 2006 capital trial. Justice Kavanaugh, writing for a majority that included Chief Justice Roberts plus Justices Sotomayor, Kagan, and Jackson, held that the Mississippi Supreme Court unreasonably applied Batson v. Kentucky's three-step framework for challenges to peremptory strikes.The Court found the trial judge accepted the prosecutor's race-neutral explanations without giving defense counsel a meaningful opportunity to argue that those reasons were pretextual, and the state appellate court compounded the error by treating that omission as a waiver. The prosecutor, Doug Evans, used four of his twelve strikes to remove four of the five Black prospective jurors, leaving a jury of eleven white jurors and one Black juror in a Mississippi county that was then roughly 40 percent Black.The Court leaned heavily on its 2019 Flowers v. Mississippi decision, which involved the same prosecutor and the same trial judge and had already found Evans's pattern of striking Black jurors discriminatory. Federal habeas relief was appropriate because the Antiterrorism and Effective Death Penalty Act's deferential “no fair-minded jurist could agree” standard cannot rescue a state-court ruling that simply skips Batson's third step. Justice Gorsuch dissented, joined by Justices Alito, Thomas, and Barrett, arguing the record showed counsel chose silence rather than being denied an opportunity. The case now returns to the Fifth Circuit for further proceedings.Justices Revive Mississippi Death Row Inmate's Batson Claim | Law360Caesars Entertainment agreed Thursday to be acquired by Tilman Fertitta's privately-held Fertitta Entertainment in an all-cash deal valued at roughly $17.6 billion, including the assumption of approximately $11.9 billion of Caesars' outstanding debt. Shareholders will receive $31 per share, a 49 percent premium over Caesars' unaffected share price as of February 25, and the company will be delisted from Nasdaq upon closing. The agreement includes a go-shop period running through approximately July 11 — a Delaware deal-protection mechanism that lets the target board solicit competing bids without triggering a termination fee, and that helps insulate the sale process from a Revlon-flavored fiduciary-duty challenge by signaling the board actively tested the market after signing.Latham & Watkins and Skadden are representing Caesars (the latter on antitrust), White & Case is advising Fertitta, and Freshfields is counseling the Carano family, which holds a roughly 5 percent stake and will roll part of its equity into the combined entity. The combined company would control more than 60 casino resorts and over 200 retail sports betting locations under the William Hill brand. Antitrust review will be the inflection point given the overlap on the Las Vegas Strip — where Caesars operates eight properties — and across digital betting. Funding will come from Fertitta equity and committed debt financing arranged by a syndicate of ten banks.4 Firms Steer Fertitta's $17.6B Caesars Entertainment Buy | Law360The Department of Health and Human Services on Thursday finalized a long-awaited overhaul of the federal Independent Dispute Resolution process under the No Surprises Act of 2021, the statute that pulls most out-of-network billing fights out of the patient's hands and into a baseball-style arbitration between provider and payer. The headline change slashes the per-party administrative fee from $115 to $15 per case, undoing a sharp 2023 hike that providers had successfully challenged in the Eastern District of Texas as having been adopted without notice-and-comment rulemaking under the Administrative Procedure Act.The rule also expands batching, so economically similar items and services can be bundled into a single arbitration, which the agency says will cut transaction costs and ease the chronic IDR backlog. HHS is also rolling out a centralized federal dispute portal and a payer registry intended to fix the persistent problem of providers being unable to identify which entity is actually on the hook in any given case. Reactions from physician and radiology groups have been mixed, with broad support for the fee cut but lingering concern that the qualifying payment amount methodology — the benchmark arbitrators must consider — still tilts the field toward insurers. APA Section 706 challenges to portions of the earlier IDR framework remain pending in the Fifth Circuit.US HHS finalizes rule to streamline dispute resolution under No Surprises Act | ReutersABC's New York affiliate WABC-TV filed an objection with the FCC on Thursday, calling Chairman Brendan Carr's April order requiring early license renewals for all eight ABC-owned stations an “unconstitutional” act of viewpoint-based retaliation barred by the First Amendment. WABC submitted its renewal under protest, arguing the agency has not demanded simultaneous early renewals from a commonly owned station group in more than fifty years and that the Media Bureau's stated rationale — possible violations of the Communications Act of 1934 and the FCC's nondiscrimination rules — is pretext for punishing disfavored editorial speech.The doctrinal hook is the Bantam Books line of cases through last term's NRA v. Vullo, which holds that government officials cannot use the implicit threat of regulatory sanction to coerce private intermediaries into suppressing protected expression. The order followed a separate FCC inquiry into whether “The View” has been violating the agency's equal-time rule for political candidates, and came against the backdrop of repeated White House demands that Disney fire Jimmy Kimmel. Democratic Commissioner Anna Gomez has openly urged Disney not to “flinch.”On the same day, the FCC issued a broader notice warning all broadcasters that licenses could be reviewed early if stations are deemed to be failing their statutory public-interest obligation — a posture that drops the question of broadcast licensing back into Red Lion-era First Amendment territory.FCC Targeting ABC Licenses To Punish Speech, Station Says | Law360 This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.minimumcomp.com/subscribe

Good morning from Pharma Daily: the podcast that brings you the most important developments in the pharmaceutical and biotech world. Recent updates offer a fascinating glimpse into an industry marked by dynamic shifts and groundbreaking advancements, each promising to reshape the future of healthcare. Let's delve into some of the most notable developments that are capturing attention across the globe. Starting with Eli Lilly's obesity medication, Zepbound, which has regained insurance coverage through CVS Caremark. This decision is emblematic of a broader recognition of obesity as a significant health issue that demands comprehensive treatment solutions. The reinstatement of coverage enables more patients to access Zepbound, potentially setting a benchmark for other insurers and leading to improved health outcomes. Shifting focus to oncology, AbbVie has secured FDA approval for a new therapy derived from its acquisition of ImmunoGen, adding to its portfolio of antibody-drug conjugates (ADCs) with Elahere. This development underscores the escalating value of ADCs in precision cancer therapies, offering innovative solutions for targeting cancer cells while preserving healthy tissues. Japan's pharmaceutical R&D stance is under examination as Prime Minister Sanae Takaichi meets with over 20 industry leaders to discuss maintaining the nation's competitive edge. This gathering highlights a global race among nations to enhance their R&D capabilities, ensuring leadership in pharmaceutical innovations. In neuroscience, Novartis's relentless pursuit to conquer the blood-brain barrier reflects ongoing efforts to revolutionize treatments for neurological disorders. Despite recent advancements, Novartis continues to explore new strategies for drug delivery to the brain, aiming to unlock therapies for conditions like Alzheimer's and Parkinson's disease. Viridian Therapeutics' collaboration with Wuxi Biologics marks a notable push in the eye drug market, positioning them against major players like Amgen. This partnership emphasizes manufacturing capability as a critical factor in ensuring resilient supply chains and competitive advantage. The hepatitis B treatment landscape has witnessed significant progress with GSK's phase 3 trial results for its drug Bepirovirsen. Achieving a functional cure in around one-fifth of patients signifies a major step forward in addressing this widespread disease. The potential to reduce lifelong antiviral therapy and lower liver cancer rates illustrates the transformative impact of nucleic acid-based therapies. Leadership dynamics also play a crucial role in pharma strategies. PharmaEssentia's appointment of Eric Vogel highlights the industry's reliance on seasoned talent to drive market expansion and broaden therapeutic indications, particularly for its rare blood cancer drug Besremi. In longevity research, Human Longevity's collaboration with Insilico Medicine introduces Human Life Foundation Models (HLFM), leveraging AI and genomics to extend human lifespan. This initiative is part of a broader trend integrating cutting-edge technologies into healthcare research, reflecting an evolving focus on longevity and genomic sciences. Regulatory landscapes are also evolving, as seen with CMS finalizing changes to the No Surprises Act dispute resolution process. By streamlining arbitration amidst rising disputes, these updates aim to refine healthcare policy frameworks for more efficient stakeholder service. Meanwhile, biosimilar approvals are gaining traction globally. ANVISA's approval of EMS's Ozivy in Brazil introduces a cost-effective alternative to Novo Nordisk's semaglutide (Ozempic) for type 2 diabetes. This step enhances access to affordable diabetes treatments, crucial for managing this prevalent metabolic disorder. In clinical trials innovation, D&D Pharmatech's Zabopegdutide has shown promising Phase 2 results for metabolic dysfunction-associated steatohepatitis (MASH), indicating fibrosis improvement and potential disease resolution. These findings underscore dual receptor agonists' therapeutic promise in tackling complex metabolic conditions. Additionally, Kailera Therapeutics' KAI-4729 demonstrates significant weight loss in Phase 1 obesity trials, potentially reshaping the obesity treatment landscape by offering superior weight management options compared to existing therapies. Funding rounds like Secretome Therapeutics' successful $30 million Series A highlight ongoing investments in regenerative medicine and cell-based therapies, propelling advancements in cardiovascular disease treatment pipelines. The acquisition landscape remains active with CordenPharma's purchase of AmbioPharm, expanding peptide manufacturing capabilities across U.S. and China markets. This move meets growing demand for peptide APIs vital in drug development processes. Technological innovation remains pivotal as Biohub releases an AI World Model for protein biology to expedite therapeutic discovery processes. This tool exemplifies computational biology's integration into drug discovery efforts, enhancing efficiency and innovation. Overall, these developments illustrate a vibrant pharmaceutical and biotech landscape characterized by scientific breakthroughs, strategic partnerships, regulatory achievements, and technological advancements—all aimed at advancing patient care and expanding therapeutic possibilities across diverse medical domains. As these trends continue unfolding, they promise not only improved treatment outcomes but also a more robust global healthcare ecosystem committed to innovation and excellence. Thank you for tuning into Pharma Daily; stay informed as we continue bringing you the latest from this rapidly evolving industry.Support the show

In this episode, Patrick Velliky, Chief External Affairs Officer at HaloMD, discusses insurer participation challenges in the IDR process, the impact of outlier arbitration awards, and how providers can better navigate the No Surprises Act landscape.This episode is sponsored by HaloMD.

Episode Summary What happens when a surgeon decides she's done being underpaid and undervalued — and refuses to sell her practice to private equity? She goes out of network. That's exactly what Dr. Sarah Bryczkowski did, and in this episode she walks us through every step of how she made it work. Dr. Bryczkowski is a robotic general surgeon in Somerset County, New Jersey and a partner at Somerset Surgical Specialists. After making partner in a private practice and realizing she was barely covering overhead as an in-network surgeon, she convinced her partners to take the leap out of network. Since September of last year, they've been operating entirely out-of-network — and they've never looked back. This episode breaks down a model that most physicians have heard about but don't fully understand. Sarah demystifies the billing process, explains what the No Surprises Act actually means for surgeons and patients, and talks honestly about the financial risks, the leap of faith, and what it finally feels like to get paid what you're worth. What You'll Learn in This Episode What "out of network" actually means — and why insurance companies don't want you to understand it How the No Surprises Act changed the game (for better and for worse) What balanced billing really is — and how it's used to scare patients away from out-of-network doctors How Independent Dispute Resolution (IDR) works and why surgeons are winning The billing workflow: from consult to arbitration (and why you won't see money for 3–6 months) How Dr. Bryczkowski convinced her skeptical partners to make the switch The partnership track reality — why making partner isn't always what you expect What the first year in an out-of-network practice actually looks like financially The metrics to watch so you're not flying blind on income Who this model is and isn't right for How to find a billing company and legal team you can trust Key Quotes "I'm doing quality surgery. I wanted to find a way to get paid what I'm worth for what I do — and the employed model didn't fit." "Balanced billing is a term insurance companies use to scare people away." "Even if I wasn't making money, I wouldn't want to be told what to do. It's worth it." "I don't have people problems, I have checklist problems." "You're sucking wind now, but as long as you've got the metrics, you know you're gonna be okay." "It's a journey of faith and challenge and courage — but it's so worth it." Resources Mentioned Somerset Surgical Specialists — somersetsurgical.com The No Surprises Act (2021) Independent Dispute Resolution (IDR) process Online directories for in-network/out-of-network physician lookup About Dr. Sarah Bryczkowski Dr. Sarah Bryczkowski is a robotic general surgeon and partner at Somerset Surgical Specialists in Somerset County, New Jersey. She trained at Hackensack University Medical Center, where she was first exposed to the out-of-network practice model. After several years in both employed and in-network private practice settings, she led her practice group to transition out of network — without selling to private equity. She specializes in complex robotic surgery including component separations, hiatal hernia repairs, and fundoplications.

Join attorneys Cindy Merrell and Bryan Dunton as they take a deep dive into real-world cases involving the No Surprises Act. Cindy and Bryan break down how the Act is being applied, highlight common issues and pitfalls, and discuss what these cases mean for payors, providers, and other stakeholders navigating these billing disputes.

Doctors are flocking to arbitration under the 2020 consumer protection law to settle pricing disputes with insurers. They're winning, often securing high prices. Guest:Margot Sanger-Katz, reporter, The New York TimesLearn more and read a full transcript on our website.Want more Tradeoffs? Sign up for our free weekly newsletter featuring the latest health policy research and news.Support this type of journalism today, with a gift. Hosted on Acast. See acast.com/privacy for more information.

It is time again for the fastest 20 minutes in podcasting as Cindy Merrell and Corey Crigger take over the Empowering Plans podcast to preview The Kentucky Derby. Don't worry, this podcast isn't solely about horse racing! Cindy and Corey also discuss two big news items that affect the healthcare industry – litigation surrounding Roundup and a major article in the New York Times about the No Surprises Act. Don't be left in the dust. Tune in to hear their insights into healthcare and  horse racing prognostication! 

In this episode of The Consumer Finance Podcast, Chris Willis is joined by Troutman Pepper Locke Partners Stefanie Jackman and Brent Hoard to take a close look at the world of medical debt collection. The discussion covers how HIPAA applies to medical debt, what it really means to be a "business associate," and common privacy challenges that can turn routine collection efforts into regulatory headaches. They also focus on key federal and state debt collection regimes, including the FDCPA, the No Surprises Act, and increasingly complex credit reporting requirements. The group provides insight on collection strategies for health care providers and third-party collectors that are both compliant and workable in practice. For anyone handling medical-related receivables, this episode serves as a practical guide to safeguarding patient information, maintaining tax-exempt status, and enhancing collections while staying within regulatory boundaries. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Surprise billing for patients is largely gone, so why are so many self-funded employer health plans still getting hammered by out-of-network costs? We sit down with Scott Bennett, Chief Provider Relations Officer at the PHIA Group, to unpack what the No Surprises Act is doing in the real world and why federal arbitration is starting to look less like a safety valve and more like a payment engine.Scott walks us through the mechanics that matter: QPA as the median contracted rate, the short open negotiation window, and the IDR process where an arbitrator picks one of two numbers. Then we dig into the headline signals from PHIA's national NSA report analyzing more than 1.25 million federal IDR disputes across 23,000-plus providers. When offers land five to six times above QPA and initiating parties win around 80% of the time, it creates a powerful incentive to file early and file often. For employer-sponsored health plans, especially self-funded groups like school districts and public safety employers, that can translate into budget shocks, higher renewals, and rising stop-loss pressure even when members never see a bill.We also explore why a small cluster of providers can drive a disproportionate share of disputes, what hotspots in certain states may be telling us about market power and network penetration, and how brokers and benefits advisors can protect clients with better data, tighter timelines, and a real IDR strategy instead of a reactive scramble. If you advise plan sponsors, this is a must-listen on NSA compliance, healthcare cost containment, fiduciary responsibility, and the evolving economics of out-of-network reimbursement.If this helped you, subscribe, share it with a colleague, and leave a review so more plan sponsors and advisors can find the conversation. What IDR pattern are you seeing in your own claims data?

Send us Fan MailHave you ever thought your top-tier insurance fully covered IVF, only to be hit with a $20,000 out-of-pocket bill? On this episode of Taco 'Bout Fertility Tuesday, Dr. Mark Amols pulls back the curtain on the confusing and frustrating world of reproductive medicine insurance.We break down the two biggest financial illusions in fertility care:The ERISA Loophole: Discover the difference between fully insured and self-funded corporate plans, and learn why state IVF mandates might not legally apply to your employer.The Out-of-Network Lab Trap: Find out why your doctor might be in-network, but the embryology lab is not—and why the "No Surprises Act" won't protect you from these massive bills.Finally, we discuss the newly reintroduced HOPE Act—a federal bill designed to close the corporate insurance gap—and equip you with the three essential questions you must ask your financial coordinator before starting treatment so you don't get burned.Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com.Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com.Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

In this episode, Suzanne Spradley and Chase Cannon review the outlook of health policy in the current Washington, DC environment. Suzanne leads off, setting the stage with a description of the narrow House Republican majority and its impact on enacting legislation. Suzanne and Chase discuss several pieces of legislation focused on transparency, including site-neutral payment reform and drug pricing. The two address regulatory activity that potentially targets PBMs and No Surprises Act issues. The episode concludes with a discussion of legislative and regulatory impact on employer group health plans.

Innovation occurs across many areas, and compliance professionals need not only to be ready for it but also to embrace it. Join Tom Fox, the Voice of Compliance, as he visits with top innovative minds, thinkers, and creators in the award-winning Innovation in Compliance podcast. In this episode,  host Tom Fox welcomes Evan Sampson, a noted health care compliance attorney. Sampson traces his path from commercial litigation to representing healthcare practices on HIPAA/privacy and reimbursement matters, then moving in-house at a network of plastic surgery centers, where he managed compliance focused on fraud, waste, and abuse, and on evolving out-of-network billing rules leading into the No Surprises Act. Sampson explains how compliance programs can create business value beyond risk mitigation by uncovering inefficiencies and opportunities, such as identifying downcoding in medical billing and using complaint investigations to spot growth areas. He describes how his litigation background helps him anticipate how issues will unfold over time in investigations and litigation, thereby improving his credibility with business leaders. They discuss building a culture of compliance in fast-growing healthcare organizations, tracking regulatory changes across primary and secondary sources, and leveraging AI and data analytics to detect claim outliers and strengthen compliance. Key highlights: Healthcare Compliance Shift Fraud, Waste, and Abuse Compliance Creates Value Building Compliance Culture Tracking Regulatory Changes AI in Compliance Analytics Resources: Evan Sampson on LinkedIn Post & Schell Innovation in Compliance was recently honored as the Number 4 podcast in Risk Management by 1,000,000 Podcasts.

In this episode, Patrick Velliky, Chief External Affairs Officer at HaloMD, breaks down the latest trends in health care policy, payer consolidation, and the No Surprises Act. He explains how providers can navigate reimbursement challenges, reduce administrative burdens, and focus on delivering care while staying independent.This episode is sponsored by HaloMD.

Sen. Cassidy Releases FDA Modernization Recommendations NIH Director Bhattacharya to Lead CDC in Acting Capacity Senate Republicans Urge Recovery of Fraudulent ACA Subsidy Payments New GAO Reports on Impact of No Surprises Act, Gain-of Function Research ACIP Delays February Meeting and more...

The No Surprises Act (NSA) continues in 2026, protecting patients from surprise bills for emergency care and certain out-of-network services, with key developments involving extended enforcement discretion for the Qualified Payment Amount (QPA) calculation (possibly to August 2026) and ongoing regulatory focus on GFE's and IDR's. However, there are Congressional stalls with legislation to also protect providers. In this episode of the Edge podcast, Terry welcomes back Healthcare attorney Amanda Waesch, to discuss the current NSA policy enforcement and when is it time to contact an attorney?

Live from the NTL Summit in Miami, trial attorney Glen Ged shares how his firm takes on powerful corporations to fight for injured people, from personal injury and mass torts to medical collections and “No Surprises Act” cases. He reflects on landmark cases that changed product safety, the growing impact of PFAS contamination, and why real trial lawyers remain one of the few forces capable of keeping corporate America in check.

In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O'Hara share the latest information TPAs and employer plan sponsors need to know about the No Surprises Act. The discussion focuses on recent federal guidance, updated arbitration data, key court decisions affecting NSA enforcement, and practical takeaways for managing provider billing disputes and controlling plan exposure in 2026.

SummaryIn this episode of The Compliance Guy, Sean Weiss interviews Joe Rivet, a healthcare attorney with extensive experience in federal matters, including prior authorization processes and the No Surprises Act. They discuss the potential changes in legislation regarding prior authorizations, the challenges faced by physicians in getting necessary treatments approved, and the implications of recent Supreme Court rulings on healthcare legislation. Joe shares insights on navigating appeals, the importance of advocating for patients, and the complexities of the IDR process.TakeawaysPrior authorization processes are being scrutinized for their impact on patient care.The proposed 'Doctors Know Best' bill aims to empower physicians.Advocating for patients is crucial, especially in off-label drug use cases.The No Surprises Act has significant implications for healthcare providers and patients.There is a lack of private right of action under the No Surprises Act.The IDR process is complicated and often exploited by private companies.Medical necessity determinations can be challenged, even after prior authorization approval.Physicians should not accept denials without exhausting all options.Recent Supreme Court rulings have clarified the limitations of private actions in healthcare disputes.Transparency in enforcement actions is needed for better accountability in healthcare.

The ultimate challenge of operating an OBL is staying profitable. In this episode of BackTable, we bring on healthcare administrator Laurie Bouzarelos and interventional radiologist Dr. Mary Costantino to talk through the intricacies of revenue cycle management as an IR managing an OBL. --- SYNPOSIS The conversation covers the full lifecycle of getting paid in an IR practice, from initial patient contact through final claim resolution. Key topics include credentialing, determining medical necessity, coordination of benefits, prior authorizations, and the importance of working with billing and practice management teams experienced in interventional radiology. The episode also examines how EHR and practice management platform selection impacts clinical workflows and reimbursement, and closes with a discussion on payment plans and how emerging technologies, including AI, may shape the future of revenue management in IR-led OBLs. --- TIMESTAMPS 00:00 - Introduction 01:08 - The Importance of Revenue Cycle Management09:29 - The No Surprises Act and Data Transparency12:03 - Professional Societies and Continuing Education17:50 - Credentialing and Taxonomy Codes40:28 - Impact of Insurance Credentialing on Patient Care42:08 - Revenue Cycle Management Walkthrough48:18 - Challenges with Medicare Advantage and Coordination of Benefits54:20 - Covered vs. Non-Covered Services59:03 - Medical Necessity and Insurance Policies01:01:04 - Prior Authorization and Payment Issues01:13:11 - Payment Plans and Compliance01:23:10 - Practice Management Software01:31:10 - AI in Healthcare and Compliance01:38:57 - Final Thoughts --- RESOURCES Medical Group Management Administration (MGMA)https://www.mgma.com/

In this episode, Patrick Velliky, Chief External Affairs Officer at HaloMD, joins the podcast to discuss emerging trends in independent dispute resolution under the No Surprises Act. He shares insights on arbitration outcomes, key financial metrics, and how providers and facilities can use IDR to strengthen payer negotiations and stabilize revenue.This episode is sponsored by HaloMD.

In this episode, Patrick Velliky, Chief External Affairs Officer at HaloMD, joins the podcast to discuss how recent legal challenges are reshaping the No Surprises Act. He shares what hospital and finance leaders need to know about arbitration opportunities, payer compliance, and preparing for upcoming regulatory changes.This episode is sponsored by HaloMD.

Join attorneys Bryan Dunton and Cindy Merrell as they discuss what happens when the No Surprises Act collides with subrogation. They explore the practical implications of the legislation, including how it intersects with common recovery models like “pay and chase” and “pend and pay.” This conversation offers valuable insights into how the Act may affect your approach to healthcare claims and reimbursement strategies.

Daylight Savings Time changeover health myths busted; A doctor breaks her ankle and is billed $64,000 in uncovered expenses; Vitamin D shields life-prolonging telomeres, may help depression; The vaunted DASH Diet for hypertension faces off against low-carb alternative; The critical first 1000 days after conception—early life sugar avoidance yields major later life health dividends; Do you really need hot water to disinfect your hands?

This episode features Thomas A. Shaffrey, MD, Primary Care and Hospitalist at Steward Medical Group, sharing his insights on the No Surprises Act, the importance of strong contracting for practices, and the challenges facing U.S. hospitals and physicians. Dr. Shaffrey emphasizes the value of physician involvement in business and policy to ensure healthcare sustainability and patient access.

Welcome back to the Bar! Summer Break is over, and there's a lot to discuss. But first, welcome back to one of the original proprietors of the Bar, Kerri Willis, who joins Ed Doherty to discuss the Independent Dispute Resolution process that was created as part of the No Surprises Act. The process has created some surprising outcomes that may be interesting to those who run employer group health plans. And in Last Call, Ed asks “What's your sign…no, what's your sign really?”

Anesthesiologists (ASA), Desiree Chappell and Sol Aronson discuss the evolving economics of anesthesiology with guests Jonathon Gal, MD, Professor of Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, System Medical Director- Facility Revenue Integrity & Optimization; System Medical Director- Offsite ASC Anesthesia; ASA Director from New York for the Board of Directors and Chair of the Committee on Economics and Gordon Morewood, MD, Anesthesiologist-in-Chief of Temple University Health System, Chair and Professor of Clinical Anesthesiology at Lewis Katz School of Medicine at Temple University and Chief of Anesthesia at Piedmont Health (Piedmont Healthcare System, Georgia). The conversation spans various models of payment, including CPT codes, fee-for-service, and alternative payment models. They delve into the nuances of navigating different payer systems like Medicare, Medicaid, and private insurers, highlighting recent trends and challenges. Specific topics include the erosion of physician payments, the impact of the No Surprises Act, and the ASA's ongoing advocacy efforts. The episode underscores the importance of proper economic strategies to ensure the sustainability and optimization of anesthesiology practices.

The No Surprises Act and Good Faith Estimates were designed to protect patients, but they've also created new operational challenges for providers, particularly around patient credits and managing refunds. In this episode of Healthcare Insider, Jessica Lemoine, AVP and Healthcare Success Manager at Fifth Third Bank, shares her insights on how health systems can navigate these complexities and modernize the patient financial experience. Listeners will learn: How financial transparency rules are increasing patient credits and what that means for providers The biggest operational and patient experience challenges in refund management Innovative tools and workflows that streamline refunds and improve consumer trust Tune in to hear how health systems can embrace automation, flexible payment solutions and financial partnerships to create a more seamless and consumer-centric patient payment journey.  

Having a baby is expensive, but how much does it really cost? Even with insurance supporting you, there can be a number of surprising costs. So how can parents to be plan for the bill? In today's episode of Yoga|Birth|Babies I speak to naturopathic doctor Dr. Ashley Burkman whose personal experiences navigating health care costs have led her to speak on the topic of health care costs. Dr. Burkman discusses understanding what is covered by insurance (and how to figure this out), the No Surprises Act, deductibles, lowering the cost of birth, what to do if you don't have insurance, and how to deal with medical bills. New parents shouldn't be surprised by a big bill from birth. This conversation will help you figure out how to estimate costs so that your early days as a parent aren't overshadowed by bills. Get the most out of each episode by checking out the show notes with links, resources and other related podcasts at: prenatalyogacenter.com Don't forget to grab your FREE guide, 5 Simple Solutions to the Most Common Pregnancy Pains HERE  If you love what you've been listening to, please leave a rating and review! Yoga| Birth|Babies (Apple) or on Spotify! To connect with Deb and the PYC Community:  Instagram & Facebook: @prenatalyogacenter Youtube: Prenatal Yoga Center Learn more about your ad choices. Visit megaphone.fm/adchoices

What happens when insurance companies and emergency physicians clash over fair payment, leaving patients caught in the middle? In this Echo Episode, part two of a two-part series, Dr. Andrea Austin talks with Dr. Jillian Schmitz about the pressing challenges in emergency medicine today.Dr. Schmitz explains the intricacies of surprise billing, where out-of-network emergency care leads to unexpected patient costs, and the No Surprises Act's intent to protect patients by removing them from billing disputes. She highlights the implementation challenges, including insurance companies' failure to follow regulations, skyrocketing arbitration fees, and delays in payments that threaten small practices. The conversation also explores ACEP's advocacy efforts, the power of collective action, and an exciting initiative to accredit emergency departments to set standards for resources, staffing, and transparency.You'll hear how they:Break down surprise billing and its impact on patients and emergency physiciansExpose flaws in the No Surprises Act's implementation, including insurance companies' manipulation of dispute processesAdvocate for collective action through ACEP membership, Political Action Committee (PAC) contributions, and sharing real-world storiesPropose accrediting emergency departments to ensure proper resources and fair practice environmentsChallenge misconceptions about ACEP's ties to corporate medicine and emphasize its physician-led advocacyIf you're an emergency physician feeling the weight of systemic challenges or seeking ways to drive change, this episode offers practical insights, advocacy strategies, and a hopeful vision for the future of emergency medicine.About the Guest:“Emergency physicians are resilient—we adapt to challenging situations with little information and make the best of it.” – Dr. Gillian SchmitzDr. Gillian Schmitz is a professor at the Uniformed Services University and an emergency physician at Brooke Army Medical Center in San Antonio, Texas. As the  past president and a member of the Board of Directors of the American College of Emergency Physicians (ACEP), she has been a leading voice in addressing workforce challenges, burnout, and policy reform in emergency medicine. A civilian working in military medicine, Gillian's career blends clinical practice, academic teaching, and advocacy, inspired by her commitment to serving those who serve the country. Her work focuses on fostering resilience, improving team dynamics, and advocating for systemic changes to support emergency physicians.

Several states have announced they'll create their own vaccine distribution guidelines as confusion continues at the federal level. Telehealth company Remedy Meds is set to acquire its rival, Thirty Madison. And a new study shows that the No Surprises Act helped lower out-of-pocket healthcare costs for consumers.Those stories coming up on today's episode of the Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.

In this powerful and unfiltered episode, Dr. Joseph Rodriguez — CRNA, former state and national leader, faculty member, and host of Anesthesia Deconstructed — takes us inside the real lessons of anesthesia leadership.From COVID-era disruption to contract losses, difficult boardroom conversations, and the relentless financial pressures of today's anesthesia market, Joe shares stories that few leaders are willing to tell. Each story carries a hard-won lesson: why leadership is never just a title, how executive presence shapes outcomes, why data transparency can backfire, and how accountability transforms teams from fragile to high-performing.We also dive into the frameworks that shaped his leadership journey — from Crucial Conversations to The Four Agreements and Five Dysfunctions of a Team — and how every leader can apply them to grow themselves, their organizations, and the people they serve.This isn't theory. It's frontline leadership, with all the scars, pivots, and resilience required to survive in one of healthcare's most disrupted specialties.Whether you're a CRNA, SRNA, or a healthcare leader navigating change, this conversation is a masterclass in turning setbacks into systems, failures into frameworks, and words into lasting impact.Keywords:Anesthesia, CRNA Leadership, Healthcare Business, Executive Presence, Leadership Lessons, Nurse Anesthesiology, Organizational Growth, Accountability, Professional Development, Anesthesia Contracts, No Surprises Act, Healthcare Strategy, Team Building, Crucial Conversations, Five Dysfunctions of a TeamSend us a textFollow us at:InstagramFacebookTwitter/X

In this bold and revealing episode, we sit down with Randy Moore — former military CRNA, past CEO of the AANA, and now a top executive at one of the country's largest anesthesia organizations — to explore how the anesthesia market unraveled, and why no one stopped it.From workforce blind spots to failed strategic planning, Randy walks us through the early warning signs that went unheeded, the flawed assumptions that fueled collapse, and the slow-motion crises that turned into full-blown disruption. We break down the shift from hospital dominance to ASC migration, the chilling effects of the No Surprises Act, and how private equity's playbook fell apart.But we don't stop at systems. Randy also gets personal — reflecting on the cost of unchecked ambition, the value of thoughtful leadership, and the non-negotiables he now looks for in partners and teams.Whether you lead a group, manage hospital operations, or just want to understand the business forces reshaping anesthesia, this conversation pulls no punches — and offers rare clarity from someone who's led on every side of the table.Keywords:Anesthesia, CRNA Leadership, Healthcare Strategy, No Surprises Act, Workforce Crisis, Private Equity, Surgical Services, Hospital Operations, ASC Growth, Healthcare LeadershipSend us a textFollow us at:InstagramFacebookTwitter/X

Stephen Parente, former White House Chief Economist for Health Policy and current Minnesota Insurance Industry Chair of Health Finance and Associate Dean at the Carlson School of Management, joins host Joe Grogan to discuss the state of healthcare transparency. They dive into the pros and cons of price transparency, the impact of the No Surprises Act, challenges for insurers and providers, and what transparency means for healthcare costs and future policy. Parente also hosts the On Background podcast, where he explores key issues in health finance and public policy.

What is next in the fight to manage waste, fraud, and abuse in Medicaid now that the One Big Beautiful Bill (OBBB) is law?  Join AnneMarie Schieber, managing editor of Health Care News and Devon Herrick, of the Goodman Institute Health Blog as they discuss the latest headlines in health care from a free market perspective. Will there be an effort to make states more financially responsible for their Medicaid programs outside the OBBB?  How will states manage Medicaid work requirements and will work requirements ultimately eliminate Medicaid waste? Also, it appears Congress is ready to tackle  “site neutral payments” under Medicare, the latest Supreme Court decisions impacting “Medicaid Provider of Choice” and required preventative screenings under the Affordable Care Act. And, did the 2020 No Surprises Act make an impact in surprise medical bills and balance billing? Plus, health savings account expansion and what this means to patients. In The Tank broadcasts LIVE every Thursday at 12pm CT on on The Heartland Institute YouTube channel. Tune in to have your comments addressed live by the In The Tank Crew. Be sure to subscribe and never miss an episode. See you there!Climate Change Roundtable is LIVE every Friday at 12pm CT on The Heartland Institute YouTube channel. Have a topic you want addressed? Join the live show and leave a comment for our panelists and we'll cover it during the live show!

What is next in the fight to manage waste, fraud, and abuse in Medicaid now that the One Big Beautiful Bill (OBBB) is law?  Join AnneMarie Schieber, managing editor of Health Care News and Devon Herrick, of the Goodman Institute Health Blog as they discuss the latest headlines in health care from a free market perspective. Will there be an effort to make states more financially responsible for their Medicaid programs outside the OBBB?  How will states manage Medicaid work requirements and will work requirements ultimately eliminate Medicaid waste? Also, it appears Congress is ready to tackle  “site neutral payments” under Medicare, the latest Supreme Court decisions impacting “Medicaid Provider of Choice” and required preventative screenings under the Affordable Care Act. And, did the 2020 No Surprises Act make an impact in surprise medical bills and balance billing? Plus, health savings account expansion and what this means to patients.

In this episode, Suzanne Spradley and Chase Cannon discuss the No Surprises Act (NSA) and its impact on out-of-network (OON) billing, with the independent dispute resolution (IDR) process at its core. Suzanne starts with an outline of the NSA and OON billing, how surprise bills arise, and how the IDR process is meant to help with carrier and provider disputes on bill payment amounts. Suzanne and Chase discuss CMS's involvement and the data gathered, shedding light on how IDR entities are selected, how disputes are handled, who's winning, and the amounts being paid. The two close with a discussion of the fairness of the process and the impact on healthcare costs for employers and their group health plans.

Steven Parente, former White House Chief Economist for Health Policy and current Minnesota Insurance Industry Chair of Health Finance and Associate Dean at the Carlson School of Management, joins host Joe Grogan to discuss the state of healthcare transparency. They dive into the pros and cons of price transparency, the impact of the No Surprises Act, challenges for insurers and providers, and what transparency means for healthcare costs and future policy. Parente also hosts the On Background podcast, where he explores key issues in health finance and public policy.

Since the implementation of the No Surprises Act (NSA) in January 2022, out-of-network (OON) reimbursement has become a complex and resource-heavy challenge for hospital and health system revenue cycle leaders. Although designed to shield patients from unexpected medical bills, the legislation has placed continuous financial pressure on physician practices and hospital systems. It has led […] The post No Surprises Act and OON Claims appeared first on Terry Fletcher Consulting, Inc..

Since the implementation of the No Surprises Act (NSA) in January 2022, out-of-network (OON) reimbursement has become a complex and resource-heavy challenge for hospital and health system revenue cycle leaders. Although designed to shield patients from unexpected medical bills, the legislation has placed continuous financial pressure on physician practices and hospital systems. It has led […] The post No Surprises Act and OON Claims appeared first on Terry Fletcher Consulting, Inc..

GPPR Podcast Editor Mitchell Zupko (MPP'25) chats with Devin Gerzof, the Executive Director of Executive Branch Relations and Federal Relations at the American Hospital Association. They discuss the No Surprises Act, site neutral payments, reimbursements, the 340B Program, and more.

*Content warning: infant loss, death, birth trauma, medical trauma and neglect, fraud, scams. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsMarkeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://linktr.ee/momsadvocatingformoms Please sign the survivors petition below to improve midwifery education and regulation in Texas: https://tinyurl.com/SWWS23 *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Balance billing: Independent Dispute Resolutionhttps://www.tdi.texas.gov/medical-billing/index.html#:~:text=Texas%20and%20federal%20laws%20prohibit,with%20a%20surprise%20medical%20bill. CMS, The No Surprises Act's Prohibitions on Balancing Billinghttps://www.cms.gov/files/document/a274577-1a-training-1-balancing-billingfinal508.pdf Do Certified Professional Midwives Need Medical Malpractice Insurance? Understanding the Legal Requirementshttps://www.rcins.com/do-certified-professional-midwives-need-medical-malpractice-insurance-understanding-the-legal-requirements/#:~:text=Texas%3A%20In%20contrast%2C%20Texas%20does,to%20carry%20medical%20malpractice%20insurance. How Expanding the Role of Midwives in U.S. Health Care Could Help Address the Maternal Health Crisishttps://www.commonwealthfund.org/publications/issue-briefs/2023/may/expanding-role-midwives-address-maternal-health-crisis#:~:text=Midwives%20are%20licensed%20health%20care,women%20at%20double%20the%20rate. Implementation of 2015 Sunset Recommendationshttps://www.sunset.texas.gov/public/uploads/files/reports/Implementation%20of%202015%20Sunset%20Recommendations.pdf The Legislative Process in Texashttps://tlc.texas.gov/docs/legref/legislativeprocess.pdf National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Practicing Medicine Without a Licensehttps://www.criminaldefenselawyer.com/resources/practicing-medicine-without-a-license.htm#:~:text=Many%20states%20make%20it%20a,fine%20of%20up%20to%20%2410%2C000. Regulation of Birth Attendants in Texashttps://texashomebirth.com/regulation-2/ Texas Board of Nursing https://www.bon.texas.gov/ Texas Department of Insurance https://www.tdi.texas.gov/ Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ TDLR, Midwives Penalties and Sanctionshttps://www.tdlr.texas.gov/enforcement/midsanctions.htm Texas Health and Human Serviceshttps://www.hhs.texas.gov/ Texas Medical Board (TMB)https://www.tmb.state.tx.us/ State investigating Dallas birth center and midwives, following multiple complaints from patients, by Morgan Young for WFAA (March 29, 2024) https://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef What Do OB/GYN Nurse Practitioners Do?https://nursa.com/specialty-post/what-do-ob-gyn-nurse-practitoners-do#:~:text=OB/GYN%20nurse%20practitioners%20are,not%20licensed%20to%20deliver%20babies. What Is the Texas Medical Malpractice Statute of Limitations?https://www.nolo.com/legal-encyclopedia/what-the-texas-statute-limitations-medical-malpractice-lawsuits.html#:~:text=Like%20a%20lot%20of%20states,and%20Remedies%20Code%20section%2074.251. Which states have the highest maternal mortality rates?https://usafacts.org/articles/which-states-have-the-highest-maternal-mortality-rates/ Why Won't an Attorney Take My Texas Medical Malpractice Case?https://www.hastingsfirm.com/your-case-and-texas-law/#:~:text=Texas%20law%20has%20made%20medical,and%20many%20hours%20of%20deposition. Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Hear more from Emily Wolfe:On Spotify // On Apple Music // https://www.emilywolfemusic.com/ // instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Artificial intelligence may be changing the trajectory of the self-funded industry – but can it negotiate? In this episode of The Phia Group's Empowering Plans podcast, attorneys Brian O'Hara and Jon Jablon break down real-life examples of AI-driven responses in the No Surprises Act's Open Negotiations process that range from nonsensical to outright misleading, where negotiating with AI is like trying to haggle with a toaster. From missing claim numbers to automated counteroffers that make no sense, Brian and Jon discuss whether AI is making negotiations easier, or defeating the purpose of the statutory process to begin with. Tune in for an honest discussion of the pitfalls of AI in No Surprises Act negotiations.

Emergency room costs now make up 6% of total healthcare plan spending—why? In this episode, host Stacey Richter welcomes Al Lewis to break down the data behind rising ER expenses, separating fact from fiction. They discuss whether increased patient acuity or widespread upcoding is driving costs, the impact of the No Surprises Act, and why plan sponsors struggle to negotiate fair ER rates. Plus, Al shares actionable strategies for employers to push back against inflated charges. If you want to understand the hidden forces behind escalating ER bills, this is a must-listen. You can find the charts and links mentioned in the show notes in the link below. === LINKS ===

Last time Cora Opsahl was on the show, Michelle Bernabe, RN, KAT, wrote a comment on LinkedIn I thought encapsulated the gist of it all so well. She wrote, “[Cora] first became a mentor/ally through Relentless Health Value episode 372. … It opened a doorway to a whole group of very relentless people.” For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. I want to start there because it's a nice comment, but it's also a call to action. Think about this and think about it not in the context of being a “stakeholder” and not in the context of being an organization but in the context of humans who work at these various organizations who, combined, comprise the bucket of companies that we lumped together using the old stakeholder word. All of these individuals are making choices every day, and all of these choices, they could be made with integrity and with the patient or member in mind … or not. In real life, right now, the overwhelming majority of members/patients in this country get their clinical care and the pleasure of paying for that care or drugs within the current ecosystem we have here in the USA. For any of us, or all of us who work within that traditional ecosystem, it is up to us to choose our own legacy here. It's probably why you listen to this show in the first place, actually. There are so many RHV (Relentless Health Value) listeners who are pushing for patients against the riptide that is the profit motives of the organization that they work for. It's hard. But yeah, it's all about finding our people and supporting each other. Okay, so let's get to the “between a rock and a hard place” portion of this discussion. Hospitals and ASOs (administrative services organizations)/carriers/TPAs (third-party administrators) often enter into or sometimes enter into what amounts to anticompetitive contracts with each other. Listen to episode 395 with Brennan Bilberry for the rundown on that one. But meanwhile, the CAA, the Consolidated Appropriations Act from 2021, holds employer plan sponsors accountable and responsible to ensure that plan assets are spent prudently, that costs paid are reasonable, and that there's no conflict of interest (COI). This is the definition of what a fiduciary is supposed to do, by the way—prudent, reasonable, and no COI. Anticompetitive contracts between a carrier and a hospital are the very definition of COI. And when that COI results in higher, maybe unreasonable, prices and non-prudent spend, well, plan sponsors are put between a rock and a hard place if they stick with their existing vendors. Rosa Novo from Miami-Dade County Public Schools put this really succinctly on a panel at a 32BJ event recently. She said what amounts to, I have no choice but to actually do the right thing here, for many reasons, but one of them is I do not look good in orange. She said, my personal butt is on the line here. And furthermore, who do class action lawsuits make look bad when their company or CEO or CFO are personally sued over conflicted benefits? See the Wells Fargo lawsuit, J&J lawsuit, etc. It sucks that employers or plan sponsors get put into this pickle by their own vendors. And that's what we're talking about today. This is a conversation that starts out talking about rates (ie, prices), edges into rights (ie, plan sponsor rights), and ends up all about power. And by the way, if you're a plan sponsor, especially in New York City, maybe doing the right thing here means hatching a plan to steer and tier in your benefit design, figuring out how to, for reals, help support the efforts of 32BJ to advantage pretty much every patient near and far. The pushback I often hear to doing something like this often involves the perception that plan members are too rich to care about reasonable prices, prudent plan spending, and COI. And yeah, to state the obvious, these same people are also sophisticated enough to smell a fine opportunity for a class action lawsuit; and also, they probably do care, as more and more studies suggest. Sorry if I just stumbled onto a sacred cow. Cora Opsahl, my guest today, is the director of the 32BJ Health Fund, serving over 200,000 folks. Their ability to kick NewYork-Presbyterian, a big, consolidated, very expensive hospital, out of their network in 2018 enabled them to offer maternity benefits for $40 in total out-of-pocket for members. And also, employees got their biggest raise ever; employers got a premium holiday and a 3% rate increase for a bunch of years after that; and yeah … this is where we start the conversation today. And yeah, it's a freakin' tangled web we weave; and this tale is a perfect case study of it. It makes me even more invested in remembering my own manifesto (that was episode 400) to ensure that I can feel good about what I personally have accomplished and what I have been a part of and the net impact of my own personal actions, since I, too, very often work in the belly of the beast. Furthermore, you will find links to a template health savings calculator for plan sponsors and also a template contract (again for plan sponsors) that 32BJ has made available. More on that in the show that follows. Also mentioned in this episode are 32BJ Benefit Funds; Michelle Bernabe, RN, KAT; Brennan Bilberry; Rosa Novo; Marilyn Bartlett; Cynthia Fisher; Zack Cooper, PhD; Claire Brockbank; Andreas Mang; Chris Deacon; Elizabeth Mitchell; and Purchaser Business Group on Health.   You can learn more at health.32bjfunds.org and by following Cora on LinkedIn.   Cora Opsahl is the director of the 32BJ Health Fund, a self-insured Taft-Hartley benefit fund that sets comprehensive design parameters to ensure the 200,000 members and families of Service Employees International Union 32BJ have easy and sustained access to affordable, high-quality healthcare. Since becoming director of the Health Fund in 2021, Cora has prioritized a data-driven approach to healthcare, focusing on reducing trend; solving the affordability challenge on behalf of union members; and most important, keeping members at the center of every decision. Under her leadership, the 32BJ Health Fund has saved more than $35 million annually—which it has reinvested in new and better benefits, including the first fertility benefit for members—by removing NewYork-Presbyterian hospitals and physicians from its network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and establishing an expanded Centers of Excellence program. Most recently, Cora conducted an innovative medical request for proposal (RFP), stipulating that all finalists must have a signature-ready contract drafted by the Health Fund prior to award. By including the Health Fund–drafted contract in the RFP process, the Fund was able to negotiate an agreement that brought unprecedented visibility and increased accountability to the 32BJ Health Fund benefit. Cora is regarded as an expert in pharmacy benefit management and previously worked at Express Scripts, where she held a variety of roles, ranging from Medicare Part D to operations to strategy and acquisitions. She earned an MBA from Saint Louis University.   06:16 Why is it imperative for employers to do something differently when it comes to being plan sponsors? 09:22 How analyzing claims data allowed 32BJ Health Fund to reshape their benefit design. 12:09 What anticompetitive rights did 32BJ run into that limited 32BJ Health Fund from managing their benefit design? 14:12 How do these anticompetitive rights have quality implications as well as cost implications? 18:43 How did 32BJ Health Fund remove NewYork-Presbyterian from their network, and how much did it save 32BJ Health Fund per year? 19:46 What did the healthcare savings allow the unions and employers to do? 20:46 Study by Zack Cooper, PhD. 21:26 Why rising healthcare costs has pushed 32BJ Health Fund to move beyond benefit design to manage healthcare spend. 24:15 Why 32BJ Health Fund wants to control the contracting process. 26:00 EP419 with Andreas Mang. 27:18 What are 32BJ Health Fund's four non-negotiables? 33:17 Wall Street Journal article on health insurance contract. 35:30 Upcoming episode with Claire Brockbank. 36:14 What is the challenge that exists in our current healthcare environment? 37:43 Cora's advice on how to get high-quality healthcare at an affordable price.   You can learn more at health.32bjfunds.org and by following Cora on LinkedIn.   @CoraOpsahl discusses #fiduciaryresponsibility in #healthcare on our #healthcarepodcast. #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Dan Nardi, Dr Spencer Dorn (EP451), Marilyn Bartlett, Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9), Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn (EP446)  

In this episode of Glauc Talk, we dive into the chaos of a stressful morning and explore how emotional regulation can make a big difference in managing everyday challenges. I also reflect on some of my biggest social media mistakes and the lessons I learned from those controversies, offering valuable insights for others navigating the online world. The episode touches on the importance of taking a pause before reacting, handling crises calmly, and learning from missteps. Additionally, we discuss the shocking cost of helicopter medical transport and how recent legislation aims to prevent surprise billing in these situations. Tune in for humor, personal stories, and practical lessons on stress management, social media, and navigating healthcare costs. Takeaways: Take a pause before reacting to stressful situations—waiting even a few minutes can help you think more clearly and make better decisions. Learning from social media mistakes can lead to growth, both personally and professionally. Owning your mistakes is key to moving forward. Helicopter medical transport can be extremely expensive, with costs reaching as high as $68,000, though legislation like the No Surprises Act helps regulate billing. Emotional regulation plays a vital role in handling life's unexpected challenges, from stressful mornings to bigger crises. Staying grounded through mindfulness techniques, such as deep breathing, can help manage adrenaline-fueled reactions in high-pressure situations. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – http://www.patreon.com/glaucomflecken  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you like the scrubs I'm wearing, here's a link and discount code to get some Jaanuu Scrubs link: https://bit.ly/4cAvXbs code: DRG20 for 20% off first-time purchases* *This code works on full-price items only excluding embroidery!  If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link:  Anatomy Warehouse Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G's and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit http://www.EyelidCheck.com for more information.  Today's episode is brought to you by the Nuance Dragon Ambient Experience (DAX). It's like having a virtual Jonathan in your pocket. If you would like to learn more about DAX Copilot check out http://nuance.com/discoverDAX and ask your provider for the DAX Copilot experience. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

Providers receive a win in the latest appeals court ruling on the No Surprises Act. About 700 rural hospitals are at risk of closing, according to a new report. And a recent survey finds that less than half of Americans trust doctors. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

We've been taking a close look on this program at the burdens of medical debt. Back in 2020, Congress passed the so-called “No Surprises Act” to protect patients from unexpected big bills for out-of-network medical care — and turns out, its wider impact on health care spending has yielded mixed results. But first on the show, California’s new $20-an-hour minimum wage for fast food goes into effect today. We’ll unpack reactions.