Sunday Morning Bathroom Read (1st Gag Clause Violation of 2024 Edition)
A Weekly Read By Doug Aldeen, ERISA Attorney
Section 2.2 of the attached addendum (effective 1/1/24) to the BCBSTX ASO Agreement provides in pertinent part:
” … Employer agrees that any services in connection with the Plan… its vendor ( i.e. “everybody”: PBM, TPA, Broker, Stop Loss, Nurse Deb, entire enchilada … ) shall not engage with or contact any provider except as permitted by the Claim Administrator… “
General Observations:
A) BCBSTX’s “real” customer is its provider network. The Plan sponsor is simply grist for the mill and its employees are wage slaves to BCBSTX;
B) More importantly, what assurances did BCBSTX make to its contracted providers? Bill with impunity? Plunder and pillage with a hall pass? The details are in the Participating Provider Agreement; C) The “gag clause” viola
RELATED BLOG POSTING: Did You Read The Contract? Then Why Did You Sign It?
WHAT DOES A GAG CLAUSE HAVE ANYTHING TO DO WITH HEALTH INSURANCE?
Known colloquially as the “gag clause prohibition,” Section 201 of the CAA, codified as Section 724 of the Employee Retirement Income Security Act of 1974 (“ERISA”), prohibits a group health plan from entering into an agreement with a TPA, health care provider, or other vendor offering access to a network of health care providers that would directly or indirectly prevent the plan from accessing certain cost and quality information and providing that information to its business associates.
Gag Clauses – New Guidance and Litigation Will Inform Compliance
