Legal Channel

Annual Enrollment – Choosing the Right Health Coverage Option

  Christine Cooper, the CEO of aequum LLC and the Co-Managing Member of Koehler Fitzgerald LLC, a law firm with a national practice along with Jack Towarnicky an ERISA/Employee Benefits compliance and planning attorney, having over forty years of experience in human resources and plan sponsor leadership roles again joins eHealth Radio and the Healthcare and Legal Channels. Listen to interview with host Eric Michaels and guests Christine Cooper & Jack Towarnicky discuss the following: Painful mistakes you and/or your employer should avoid at annual enrollment. Eric: Number 10 – Christine, what’s number 10? Christine: Number 10 is an employer mistake. It is the employer who fails to offer workers a choice of coverage. Regardless of the size of the employer, the employer should anticipate a diversity of medical coverage needs, today, AND tomorrow! At a minimum, the employer should offer at least two choices, typical would be a PPO and Health Savings Account capable options. Eric: Who has number 9? Jack? Jack: Number 9 is also an employer mistake. It is the decision to use a passive process. Passive means that the worker’s existing coverage will continue unless they take action to review the options and make choices. The annual enrollment process should prompt individuals to make affirmative elections – even if it is the same choices, year after year. Eric: Interesting, so what is Number 8? Jack: Number 8 is another employer mistake. It is the failure to adjust the coverage comparison so the differences, especially the differences in provider networks and costs are apparent, obvious. For example, where a HSA-capable coverage option is offered, the employer often fails to adjust the deductible for the other choice, typically the PPO, so that the deductible for the PPO applies in the same way. Bottom line, once you have a good idea about your expected utilization, if you must spend more than 5 minutes looking at a side-by-side comparison, that means that the differences aren’t obvious, or that the comparison has too much detail. Eric: OK, three strikes and the employer are out. So, our audience now knows that the employer should offer a choice of coverage, and at least one of the options should allow the worker to save in a Health Savings Account. The employer should have an active enrollment process, not a passive process, where workers must make affirmative elections of coverage. And the side-by-side comparison should be clean and clear enough so that a worker who knows what they expect to spend on medical can make a decision in less than 5 minutes. OK. So now we have some ideas about what you might ask your employer. Eric: What’s next? What’s Lucky Number 7? Christine: More like unlucky #7. Number seven is bias. We let bias affect our decisions. We tend to make decisions by relying on heuristics, or rules of thumb. One example is where people might think Expensive is Better … that the coverage with the smallest deductible or the highest contribution must be the better choice – even though I don’t anticipate any significant medical expenses. Eric: With six you get egg roll! You could look it up. What is number six? Jack: Over insurance, you paid too much! Or, as one insurance company motto says, only pay for what you need. Over insurance can result by focusing too much on monthly or per payday costs (what is affordable) versus an estimate of all costs for an entire year. Bias also causes workers to overestimate the likelihood of easy to imagine outcomes, or recent events, what some call the availability heuristic – for example, a coworker who suffered an illness or injury. People sometimes fixate on “what if?” As in what if I need surgery? Eric: What is five? Christine: Uncertainty. Uncertainty tends to result in opportunity losses. There is a lot of uncertainty in predicting medical utilization. But, for almost everyone, medical spend increases with age. So, the time to save is now, because our out-of-pocket expenses are likely to increase in the future. And, when it comes to saving for future medical expense, the best option is the Health Savings Account. Why the HSA? Well, it saves on taxes. Often, there is an employer contribution. And consider this. Most of us are likely to make it to retirement age, when, if we are lucky enough to have avoided medical costs, we can spend HSA dollars the same way we spend money from a 401k or an Individual Retirement Account. Actually, saving in a HSA is often better than saving in a 401k. Eric: Saving in a HSA is better than saving in a 401k? Where can you find more info? Christine: Contact us at aequumhealth.com, or specifically, contact Jack with your questions about Health Savings Accounts. Or, if your employer doesn’t offer a Health Savings Account capable plan, have your employer reach out to Jack. Jack is one of America’s foremost experts when it comes to the Health Savings Account, its features and value. He’s been participating in a HSA over 17 years, since 2005. You can find his email address by visiting us at www.aequumhealth.com.  Eric: OK, we’re down to the last four. Number 4? Jack: It’s another employer mistake – choice blindness, or choice overload. Studies show that three choices are often one too many – especially for something as complex as medical coverage. Eric: Number 3? Christine: It is another employer mistake, this time in marketing or communications. Too many times, employers focus communications on the deductible. Some even name the options that way – for example, the $500 plan. That results in something economists call an “anchoring bias”. It draws an inordinate amount of attention to the size of the deductible. During annual enrollment, in your decision-making, you should compare the difference in deductibles between options, the difference in contributions between options and the difference in total costs based on your expected utilization. Eric: We are down to the Number 2 mistake. Jack: Myopia. One big mistake we all make is limiting our focus to today, next week, next month, next year. But we all expect to live beyond 2023. So, our coverage decisions should include today and tomorrow, specifically saving, improving our household’s financial resilience. Accumulating savings in 2023 ensures you are better prepared for future annual enrollment decision-making. Eric: And the Number 1 mistake people make when it comes to annual enrollment? Christine: Inertia. People are inert. Most don’t spend more than 30 minutes on benefits decision-making each year. Some skip annual enrollments altogether. I mean, nothing has changed in your life, or your household, or in the coverage marketplace, or in your employment over the past 3 years, right? Remember to ask other adults in your household for their input. If you are enrolled in the same health coverage today that you were before the pandemic, you should at least reconsider any available alternatives … just in case they changed. Also, if you are enrolled in a Health Savings Account, it is a good time to update your rate of contributions … but remember, unlike other accounts, you can prospectively change your HSA contribution rate, any month during the year. Keeping the same choice, year after year after year is a form of status quo bias. How would you know if it is still the right choice…unless you give it a new, fresh look. Don’t know where to start, ask for help. We’ll put a summary of this discussion on our website www.aequumhealth.com – so you can refer to it for this year’s annual enrollment (and future years as well). Start today. Ask your employer for the dates of the annual enrolment, and what coverage option will be offered in 2023. Have them contact Jack and encourage them to offer a Health Savings Account capable option. Start putting together your estimate what you and your household members will spend on medical in 2023. And, when annual enrollment comes, don’t forget to take time to review your choices and make an affirmative decision, election for 2023. Christine M. Cooper, CEO and Member, aequum LLC Christine M. Cooper is the CEO and Member, of aequum LLC. A patent lawyer recruited to Koehler Fitzgerald LLC in 2016 because of her large law firm experience and IT skills, Christine was quickly elevated to a member of Koehler Fitzgerald LLC and leads the health care practice. Christine is the CEO of aequum and is dedicated to assisting and defending plans and patients. Jack Towarnicky Member, aequum LLC As an ERISA/Employee Benefits compliance and planning attorney, Jack has over forty years of experience in human resources and plan sponsor leadership roles. This includes twenty-five years as the leader of a Fortune 100 corporation’s benefits function. While serving in those roles, Jack and his team won a multitude of individual, team and corporate recognitions. In 2020 Jack joined aequum and provides plan drafting and compliance services to employers and plan sponsors. About aequum Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide to protect plan participants, improve employee satisfaction with their health care plans, and generate plan and participant cost savings. aequum helps patients defend medical balance bills and brings savings to employer-sponsored health plans by providing administrative and other services to its partners. In addition, its sister organization, Koehler Fitzgerald LLC, provides legal advocacy to plan participants. Website: https://aequumhealth.com  Social Media Links: Facebook: https://facebook.com/aequumbykoehlerfitzgerald Linkedin: https://linkedin.com/company/aequumllc/about Twitter: https://twitter.com/aequumhealth   

Advanced EOB: How it works for healthcare consumers and employer-sponsored health plan members

    Christine Cooper, the CEO of aequum LLC and the Co-Managing Member of Koehler Fitzgerald LLC, a law firm with a national practice. Christine leads the firm’s health care practice and is dedicated to assisting and defending plans and patients again joins ehealth Radio and the Healthcare and Health News Channels. Listen to interview with host Eric Michaels and guest Christine Cooper discuss the following: What is the Explanation of Benefits or “EOB”? What role does it plan in your employer-sponsored health plan? What is an “Advanced” Explanation of Benefits (EOB), and how does it work for healthcare consumers and employer-sponsored health plan members? How can health plan members ask for an Advanced EOB? How does a member evaluate an Advanced EOB when received? How can they request another quote for the same procedure from a different provider? How can members work with its plan administrator for guidance and to identify a reasonable price for procedure? Christine M. Cooper is the CEO and Member, of aequum LLC. A patent lawyer recruited to Koehler Fitzgerald LLC in 2016 because of her large law firm experience and IT skills, Christine was quickly elevated to a member of Koehler Fitzgerald LLC and leads the health care practice. Christine is the CEO of aequum and is dedicated to assisting and defending plans and patients. About aequum Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide to protect plan participants, improve employee satisfaction with their health care plans, and generate plan and participant cost savings. aequum helps patients defend medical balance bills and brings savings to employer-sponsored health plans by providing administrative and other services to its partners. In addition, its sister organization, Koehler Fitzgerald LLC, provides legal advocacy to plan participants. Website: https://aequumhealth.com  Social Media Links: Facebook: https://facebook.com/aequumbykoehlerfitzgerald Linkedin: https://linkedin.com/company/aequumllc/about Twitter: https://twitter.com/aequumhealth 

The Recessionary Impact on Employer-Sponsored Health Coverage: Will it be Different this Time? Who Pays? How Much?

    Jack Towarnicky, an ERISA/Employee Benefits compliance and planning attorney, having over forty years of experience in human resources and plan sponsor leadership roles joins ehealth Radio and the Healthcare and Legal Channels. Listen to interview with host Eric Michaels and guest Jack Towarnicky discuss the following: Americans are anxious over “what’s next” in terms of increases in the cost of medical coverage and their out-of-pocket expenses, and how they will add to the existing financial stress from recent inflation and the decline in economic activity in the first half of 2022. What is your outlook? There isn’t widespread agreement about whether we are in a recession. Regardless, how will the recent decline in economic activity be different this time? Most American workers would be surprised to find out that they pay more for other people’s subsidized health coverage than for their own. Who pays, and how much? And, how much more are taxpayers going to pay into this? What is the expected impact of current inflation and economic trends on employer-sponsored coverage? How should employers and employees be thinking about health plan renewals for 2023? What actions should they be taking now, today? What can employers and employees do about the looming increase in medical costs for 2023? Jack Towarnicky Member, aequum LLC As an ERISA/Employee Benefits compliance and planning attorney, Jack has over forty years of experience in human resources and plan sponsor leadership roles. This includes twenty-five years as the leader of a Fortune 100 corporation’s benefits function. While serving in those roles, Jack and his team won a multitude of individual, team and corporate recognitions. In 2020 Jack joined aequum and provides plan drafting and compliance services to employers and plan sponsors. About aequum Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide to protect plan participants, improve employee satisfaction with their health care plans, and generate plan and participant cost savings. aequum helps patients defend medical balance bills and brings savings to employer-sponsored health plans by providing administrative and other services to its partners. In addition, its sister organization, Koehler Fitzgerald LLC, provides legal advocacy to plan participants.     Website: https://aequumhealth.com  Social Media Links: Facebook: https://facebook.com/aequumbykoehlerfitzgerald Linkedin: https://linkedin.com/company/aequumllc/about Twitter: https://twitter.com/aequumhealth 

An Opportunity to Lower Medical Costs

  Christine Cooper, the CEO of aequum LLC and the Co-Managing Member of Koehler Fitzgerald LLC, a law firm with a national practice along with Jack Towarnicky an ERISA/Employee Benefits compliance and planning attorney, having over forty years of experience in human resources and plan sponsor leadership roles joins eHealth Radio and the Healthcare and Legal Channels. Listen to interview with host Eric Michaels and guests Christine Cooper & Jack Towarnicky discuss the following: Christine, will the No Surprises Act protections against balance billing save workers money? Jack, surveys show a majority of Americans are concerned about medical bills.  Won’t the No Surprises Act eliminate those concerns? How can employers help alleviate “financial fragility” when it comes to the medical expenses their employees are not prepared to pay? How could health care consumerism potentially transform future health care coverage? What resources and services are available to help participants in a health plan defend against receiving unreasonable or excessive medical billing?
  Christine M. Cooper, CEO and Member, aequum LLC Christine M. Cooper is the CEO and Member, of aequum LLC. A patent lawyer recruited to Koehler Fitzgerald LLC in 2016 because of her large law firm experience and IT skills, Christine was quickly elevated to a member of Koehler Fitzgerald LLC and leads the health care practice. Christine is the CEO of aequum and is dedicated to assisting and defending plans and patients. Jack Towarnicky Member, aequum LLC As an ERISA/Employee Benefits compliance and planning attorney, Jack has over forty years of experience in human resources and plan sponsor leadership roles. This includes twenty-five years as the leader of a Fortune 100 corporation’s benefits function. While serving in those roles, Jack and his team won a multitude of individual, team and corporate recognitions. In 2020 Jack joined aequum and provides plan drafting and compliance services to employers and plan sponsors. About aequum Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide to protect plan participants, improve employee satisfaction with their health care plans, and generate plan and participant cost savings. aequum helps patients defend medical balance bills and brings savings to employer-sponsored health plans by providing administrative and other services to its partners. In addition, its sister organization, Koehler Fitzgerald LLC, provides legal advocacy to plan participants. Website: https://aequumhealth.com  Social Media Links: Facebook: https://facebook.com/aequumbykoehlerfitzgerald Linkedin: https://linkedin.com/company/aequumllc/about Twitter: https://twitter.com/aequumhealth   

No More Surprises! How Provisions of the No Surprises Act Will Impact Employer-Sponsored Health Plans In 2022

    Jack Towarnicky, an ERISA/Employee Benefits compliance and planning attorney, having over forty years of experience in human resources and plan sponsor leadership roles joins ehealth Radio and the Healthcare and Legal Channels. Listen to interview with host Eric Michaels and guest Jack Towarnicky discuss the following: What’s your best advice for workers when it comes to “Surprise” medical bills? As an employee benefits expert, what advice can you offer employees that is most beneficial regarding their employer-sponsored health plan? I thought you had to enroll in a health plan with a high deductible to be eligible to contribute to a Health Savings Account. Is this true? Let’s say my employer offers two different PPO options, one with a $600 deductible and the other is HSA-capable with a $1,400 deductible. Why would I sign up for the higher deductible option? Given that the employer spend is usually the same for all coverage options, why would they offer HSA-capable coverage?  Jack Towarnicky Member, aequum LLC As an ERISA/Employee Benefits compliance and planning attorney, Jack has over forty years of experience in human resources and plan sponsor leadership roles. This includes twenty-five years as the leader of a Fortune 100 corporation’s benefits function. While serving in those roles, Jack and his team won a multitude of individual, team and corporate recognitions. In 2020 Jack joined aequum and provides plan drafting and compliance services to employers and plan sponsors. About aequum Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide to protect plan participants, improve employee satisfaction with their health care plans, and generate plan and participant cost savings. aequum helps patients defend medical balance bills and brings savings to employer-sponsored health plans by providing administrative and other services to its partners. In addition, its sister organization, Koehler Fitzgerald LLC, provides legal advocacy to plan participants.     Website: https://aequumhealth.com  Social Media Links: Facebook: https://facebook.com/aequumbykoehlerfitzgerald Linkedin: https://linkedin.com/company/aequumllc/about Twitter: https://twitter.com/aequumhealth 

No More Surprises! Provisions of the No Surprises Act Will Protect Healthcare Consumers Against Certain Out-of-Network Balance Billing In 2022

    Christine Cooper, the CEO of aequum LLC and the Co-Managing Member of Koehler Fitzgerald LLC, a law firm with a national practice. Christine leads the firm’s health care practice and is dedicated to assisting and defending plans and patients joins ehealth Radio and the Healthcare and Health News Channels. Listen to interview with host Eric Michaels and guest Christine Cooper discuss the following: aequum was launched nearly a year ago. During that time aequum successfully resolved 6,000+ claims – saving over $31 million (97.2%) of disputed charges. What drove the formation of aequum and demand for your technologies and services that support health plans with medical billing? What is “Surprise Medical Billing” and how does it impact our healthcare system? What led to federal legislation and the significance of the No Surprises Act (NSA)? What medical services and claims are protected by NSA? When will the rules and provisions of the NSA take effect? What strategies can employer-sponsored health plans and their members take to prepare? Christine M. Cooper is the CEO and Member, of aequum LLC. A patent lawyer recruited to Koehler Fitzgerald LLC in 2016 because of her large law firm experience and IT skills, Christine was quickly elevated to a member of Koehler Fitzgerald LLC and leads the health care practice. Christine is the CEO of aequum and is dedicated to assisting and defending plans and patients. About aequum Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide to protect plan participants, improve employee satisfaction with their health care plans, and generate plan and participant cost savings. aequum helps patients defend medical balance bills and brings savings to employer-sponsored health plans by providing administrative and other services to its partners. In addition, its sister organization, Koehler Fitzgerald LLC, provides legal advocacy to plan participants. Website: https://aequumhealth.com  Social Media Links: Facebook: https://facebook.com/aequumbykoehlerfitzgerald Linkedin: https://linkedin.com/company/aequumllc/about Twitter: https://twitter.com/aequumhealth 

Taking the best care of your children when divorce can't be avoided

    Mrs. Stacy Beaulieu-Fawcett, founder of Beaulieu-Fawcett Law Group, that focuses only on marital and family law and serves clients in SE Florida’s Palm Beach, Broward, Martin and St. Lucie counties joins eHealth Radio and the Divorce & Legal Channels.    Listen to interview with host Eric Michaels & guest Stacy Beaulieu-Fawcett discuss the following: When a couple with children decides to divorce, what criteria should they look for when hiring a lawyer? How can parents who are divorcing take the best care of their children? What are the steps? How can using the mediation process avoid the often acrimonious appearances in a courtroom? What can divorcing couples expect when they decide to mediate their divorce? As a faithful Christian highly involved with the legal community, what are some obstacles facing some faithful persons who choose divorce? What obstacles do they need to overcome?   Mrs. Stacy Beaulieu-Fawcett, founder of Beaulieu-Fawcett Law Group, focuses only on marital and family law and serves clients in SE Florida’s Palm Beach, Broward, Martin and St. Lucie counties. Mrs. Beaulieu-Fawcett has built her thriving practice in large part by helping Christians navigate the often-difficult decision to divorce.  Mrs. Beaulieu-Fawcett is a member of the Christian Legal Society and is a deeply committed to her faith. The team of lawyers at Beaulieu-Fawcett Law Group has unparalleled experience in navigating clients though this difficult process, and handling whatever challenges may arise, be it custody or financially related. They empathize with the intense emotions clients often experience, yet are committed to practicing reasonable and sensible law and providing objective advice as to how to achieve the best possible outcome. If that requires litigation, their attorneys are highly skilled and effective in the courtroom. And when a divorce is settled without a trial, the lawyers’ drafting of settlement documents is clear, comprehensive, and straightforward to avoid unnecessary disputes later.Beaulieu-Fawcett is an esteemed and highly involved member of the local legal community. In her marital and family law practice, she is committed to protecting her client’s rights and serving their children’s best interests. Mrs. Beaulieu-Fawcett has extensive experience handling difficult and complex family law cases in a professional and compassionate manner negotiating when possible and aggressively litigating when necessary.  Prior to entering private practice, she spent several years in the courtroom assisting a Chief Family Law Judiciary. Mrs. Beaulieu lectures frequently on various family law issues throughout the state of Florida. Mrs. Beaulieu-Fawcett was featured as one of the top young attorneys in Florida on SuperLawyers.com. She was named “Florida’s Legal Elite” by Florida Trend Magazine which recognized her as top 2% of attorneys in Florida.  The Beaulieu-Fawcett Law Group focuses on family law areas including: Adoption Alimony Child Abuse Child Negligence Complex Matrimonial Matters Divorce Dissolution of Marriage Domestic Violence Interstate and International Child Abduction Mediation Parenting and Child Support Parenting Plans Paternity Post Judgement Enforcement & Modification Prenuptial Agreements Property and Marital Settlement Agreements Relocation Stepparent Adoption Substance Abuse   Website: www.BLGFL.com Facebook: www.facebook.com/BLGFL

The shadowy world of sports supplements

  Robert Tauler, managing partner at Tauler Smith, a Los Angeles attorney who protects the nutritional supplement market from people who openly sell illegal steroids and amphetamines as sports supplements joins eHealth Radio and the Health News, Legal & Supplement Channels.   Listen to interview with host Eric Michaels & guest Robert Tauler discuss the following: Tell us a bit about problem of illegal steroids being sold right out in the open online and in sports nutrition stores. How big is the problem and what’s at stake? How do these companies work and why can they operate so openly? Where’s the FDA in policing this problem? What are the most common kinds of illegal supplements being sold right now, how do they work, and what are the risks and known side-effects? Do you know of any cases of someone suffering serious physical injury from illegal supplements that you can share with us? How do you use the law to go after these bad actors? How effective have you been in getting the courts to force these people to take these poisons off the market? Who is the market these people sell to? Can you tell us something about the buyers and the sellers? Who makes these supplements? Do the makers of these supplements have any medical backgrounds or qualifications that lets them experiment on customers with unapproved pharmaceutical research drugs? How can unsuspecting people protect themselves from these substances? What should they know? How should they read a supplement’s label?   Los Angeles trial attorney Robert Tauler devotes the majority of his practice to nutritional supplement litigation, specifically eliminating steroid and amphetamine analogs from over-the-counter sports supplements. These drugs are sold openly in stores and online under all sorts of names with no warnings about side effects, whether the chemicals have been banned for human consumption, or whether they are outright illegal — as all steroids are without a doctor’s prescription.In 2016, he was  awarded "Attorney of the Year" by the Los Angeles Westside Bar Association. In 2015 he obtained a $10 million jury verdict against a supplement manufacturer, which was among the top 25 highest verdicts in California that year.Tauler, a native Californian, is a 2005 graduate from Harvard Law School. He was honored as an NCAA Big West Scholar-Athlete while an undergraduate at the University of California, Irvine, where he majored in political science and played on the Anteater’s nationally-ranked men’s volleyball team.     Website: taulersmith.com