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Are employers excluding outpatient surgeries in insurance plans? 7 key points

Despite outpatient surgery costing significantly less than inpatient procedures, many large employers are not offering employees outpatient coverage, according to The Washington Post.

Here are seven key points:

1. In 2015, companies with low-wage workers attempted to claim coverage without inpatient benefits met ACA guidelines, but regulators disagreed. This decision caused many employers to attempt a new cost-cutting measure: eliminating outpatient surgery coverage.

2. Employers save money from excluding outpatient coverage, resulting in hefty medical bills for employees undergoing outpatient surgery.

3. The government does not require large employers to offer a list of "essential health benefits." Rather, large employers are mandated to offer minimum value as determined by an online calculator and regulatory guidance, or face a penalty.

4. In 2014, federal regulators required large employer plans to provide "substantial coverage of inpatient hospital and physician services" to qualify as minimum value. However, the current debate is centered on whether "substantial coverage of physician services" includes outpatient surgery — regulators have yet to weigh in.

5. This year, insurers that don't provide outpatient surgery benefits have been marketed to many staffing companies, hoteliers and other lower-wage employers. In 2015, nearly half of the 1,600 corporate members of the American Staffing Association reported interest in plans with no inpatient coverage before regulators decided against them.

6. Many companies are offering plans without outpatient coverage including EBSO, a Minnesota-based benefits company that has implemented 2016 minimum-value plans. Similarly JFC Staffing offered its nearly 700 eligible employees a skinny plan lacking outpatient surgery benefits.

7. An American Hospital Association spokeswoman said the organization is "deeply concerned" about plans that do not offer outpatient coverage.

More articles on coding & billing:
U.S. creates stricter rules for latecomers trying to gain health insurance — 5 things to know
Health Care Cost Institute launches Guroo to provide healthcare cost, quality data — 5 points
State proposal seeks price transparency — 4 takeaways

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