A Spooky Surprise: NSA Regulations on IDR Released

On October 19, 2021
On September 30th, the federal government released a long-awaited interim final rule to enact additional components of the No Surprises Act. This rule outlines many critical processes of which self-funded health plans and other industry players must be aware, including the independent dispute resolution process and expanded rights to external review. Join the Phia team as they tap supernatural forces to reveal the secrets of this rule, explain the implications for claims and appeals, and help you stay one step ahead of the competition. This is one monster mash you do not want to miss.

A Teaser! A Rose by Any Other Name…

On October 15, 2021
I am very excited to let you know that my recent article, regarding the No Surprises Act and its impact on appeals and disputes, will be published in the upcoming issue of The Self-Insurer magazine, published by the Self-Insurance Institute of America (“SIIA”). Here I provide you with an overview of the topic that will be discussed, why this is so important, and how it all impacts our own Plan Appointed Claim Evaluator (“PACE”) service.

Empowering Plans: P120 – To Appeal, or not to Appeal

On October 15, 2021
Join The Phia Group’s CLO, Ron Peck, and SVP of Consulting, Jen McCormick, as they dissect the No Surprises Act and reveal how and why there will be confusion regarding what constitutes a basis for appeal, and what should be disputed per the NSA. This, along with updates on the cost of COVID testing, mandatory vaccine orders, and more are in store with this episode of Empowering Plans!

Empowering Plans: P119 - Workers' Compensation & COVID-19 Claims

On September 30, 2021
In this episode of Empowering Plans, Attorneys Rebekah McGuire-Dye and Cindy Merrell, discuss how current Workers’ Compensation regulations impact health plans, and who is responsible for employee’s Covid-19 related claims.

Dialysis Carve-Outs and Network Contracts: Like Oil and Water

On September 30, 2021
It’s renewal season once again, and you know what that means: time for health plans to make decisions about vendors, pay ment models, and other things that help contain costs while maintaining robust benefits! One important choice that plans need to make is about dialysis. Specifically, when the plan uses a PPO network to price and pay claims, what does that mean for dialysis claims, which are of course some of the most expensive and marked-up claims of them all?

Stories from the Front Lines – A Collection of Recent Relevant Case Studies & COVID-19 Vaccine Mandate

On September 21, 2021
It has been said that failure is often the greatest teacher. This is true both for the one that failed, as well as those who learn from others’ experiences. Join The Phia Group as they share cautionary tales meant to enlighten, and ensure you don’t make the same mistakes or fall into the same traps. From mishandled appeals to fiduciary breach; misapplication of plan terms to compliance violations; dubious provider billing schemes to abusive treatment facilities; by witnessing others’ unfortunate experiences (and hearing how The Phia Group responded), you will be better prepared when similar issues affect you. Don’t worry; the names have been changed to protect the innocent!

Covid-19 Vaccine Boosters – Are they Ethical?

On September 17, 2021
Throughout the day, the FDA be discussing whether the general American public should start getting COVID-19 vaccine booster doses. This will include presentations from Pfizer, who has been pushing for booster shots across the general population, but the FDA will provide its own interpretation of available data as well. Even before any guidance from the FDA, Dr. Fauci and the NIH have been advocating for booster doses for months.

Empowering Plans: P118 – You Can’t Always Get What You Want

On September 17, 2021
This week on Empowering Plans, Attorneys Chris Aguiar and Cindy Merrell, discuss what happens when limited settlement funds force Plans to consider a reduction. Listen in to get all of the details.

Biden Administration Announces Sweeping New Vaccine Mandates

On September 10, 2021
On September 9, 2021, President Biden announced his COVID-19 Action Plan, which seeks to impose new vaccine mandates on federal employees, health care workers at Medicare and Medicaid participating hospitals, and private sector employees.

Empowering Plans: P117 – Boost Your COVID-19 Vaccine Knowledge

On September 1, 2021
This week on Empowering Plans, there are important COVID-19 vaccine updates to discuss. Pfizer’s vaccine was granted full FDA approval, booster shots are coming, and employers are debating whether and how to implement premium penalties for the unvaccinated. What do employers and their plans need to know? Join Attorneys Brady Bizarro and Kelly Dempsey as they break it all down for you.

The Status of Major Legal Challenges to the ACA

On August 25, 2021
On June 17, 2021, the Supreme Court dismissed the latest challenge to the Affordable Care Act (“ACA”) in a 7-2 decision. Get the details in our latest blog post.

The Provider Perspective – Analysis and Response to How Providers are Reacting to Recent Rule Changes and Reform

On August 24, 2021
For months we have been dissecting new and forthcoming rule changes, to address their impact on the health benefits industry. Yet, everything from laws regarding transparency to surprise balance bills will also substantially impact the provider community as well, right? Maybe… Maybe not? Join The Phia Group for another complimentary webinar, as they assess how providers are – presently, and in the future – likely to react (or not react) to the new healthcare pricing rules, as well as address best practices to fight back against abusive provider billing tactics.

Empowering Plans: P116 – Right to Repair and Healthcare

On August 20, 2021
In this podcast episode, Phia Group attorneys discuss President Biden’s right to repair executive order and how the policy impacts healthcare. Listen now!

A Failure to Communicate

On August 13, 2021
What is insurance? Why are there problems with health insurance in the U.S.? Read about the healthcare system and insurance through the lense of COVID-19.

Empowering Plans: P115 – A Lightning Round of Healthcare Updates

On August 6, 2021
In this Empowering Plans podcast episode, Phia Group attorneys discuss healthcare topics to keep you updated on the industry. Listen to the podcast here!