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CAA #4: A Prohibition on Gag Clauses

The Consolidated Appropriations Act (CAA) prohibits health plans from entering into contracts that would restrict the plan from: Offering provider-specific cost or quality of care information to referring providers, the plan sponsor, plan participants, or persons eligible to become plan

Peter Iverson, Esq. February 17, 2021
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CAA #3: Strengthening Mental Health and Substance Abuse Parity Rules

The Consolidated Appropriations Act (CAA) included provisions designed to strengthen the rules for group health plans to impose Nonquantitative Treatment Limitations (NQTLs) on coverage for treatment of mental health and substance use disorders (MHSUDs) . NQTLs are non-numerical treatment limitations

Peter Iverson, Esq. February 15, 2021
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Advance Explanation of Benefits: the 411

What is it? An Advance Explanation of Benefits (AEOB) starts with the obligation of a health care provider to furnish a patient with an advance statement of the expected charges for a scheduled service. When do I have to provide

Peter Iverson, Esq. February 12, 2021
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CAA #2: Removing the Element of Surprise: the Consolidated Appropriations Act’s Guidelines for Group Health Plans

CAA NO SURPRISES BLOG The Consolidated Appropriations Act of 2021 (CAA) contained many provisions that directly affect employer sponsored group health plans.  In this blog, we will discuss the provisions of the CAA designed to prevent plan participants from incurring

Peter Iverson, Esq. February 9, 2021
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