The Phia Group Blog

By: David Ostrowsky The No Surprises Act (NSA) established a federal framework intended to protect patients from surprise medical bills while also providing a structured process for resolving payment disputes between payers and out-of-network providers and facilities. As the volume…

By: Matthew Kyle Health plans are facing increasing scrutiny over claim denials as new data shows that external independent review organizations overturn more than half of disputed medical, mental health, and surgical claims. Researchers found that overturn rates in New…

By: Lisa Hill, Esq. Denied claims discussions often focus on those things that should be examined, evaluated, and documented during that process. This is not another claim denial review but rather a look at how disputed denied claims might affect…

By: Naga Vivekanandan, Esq. Claim denials are having a moment, and it’s not a comfortable one for the health insurance industry. A recent analysis of external appeals in New York found that the share of denials overturned on external review…

By: David Ostrowsky While we’re soaking up the final weeks of summer, the fall—i.e., health plan open enrollment/renewal season—is quietly sneaking up on us. As a prelude to every healthcare broker’s and administrator’s favorite time of year, The Phia Group…

By: David Ostrowsky At first blush, America’s now decadeslong healthcare affordability crisis stems from such well-known culprits as inflated prescription drug prices, rampant administrative waste, and escalating deductibles and premiums. While these are all contributing factors, a more nuanced assessment…