Phia Group

Empowering Plans: P163 – ChatGPT: Disrupting the Healthcare Industry

On May 19, 2023
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O'Hara provide an overview of ChatGPT, the artificial intelligence chatbot developed by OpenAI, and describe how it is disrupting the healthcare industry. In particular, they focus on one emerging use for the technology - acting as a virtual assistant for patient care. What are the advantages of using AI in this manner? What are the concerns? Tune in for what will be a topic that we revisit in the coming weeks and months!

The Business of Benefits

On May 18, 2023
Those who service health benefit plans are usually focused on delivering the most robust coverage for the least cost. Yet, all too often we forget that our industry, like any other, only thrives when our own businesses prosper. From adjustments to a post-pandemic environment (and employee populations working remotely from numerous locations), to conflict resolution between entities (such as disputes between plans, stop-loss, and TPAs over reimbursement of fees for savings and management of the NSA), join The Phia Group as we discuss the current events and case studies that will impact whether your own organization sinks or swims.

Empowering Plans: P162 – Mind the Gap 2.0: Don’t be Afraid to Ask for a Handbook

On May 12, 2023
In this episode of Empowering Plans, Kelly Dempsey and Kevin Brady outline the relevant details provided within our Handbook Gap Free Reviews. They provide a description of the service, the case studies which gave rise to this service and describe why a review of the Handbook is more important now than ever before!

Digitizing Subrogation

On May 10, 2023
When it comes to subrogation, The Phia Group has over 20 years’ experience serving clients nation-wide. Our attorneys are some of the industry’s most well-versed subrogation experts who can relate to a wide swath of health plans – from self-insured to Medicare-based ones. But we know there can be a great deal of attrition and stiff competition in the subrogation space, which is why for the better part of the past decade there has been a company-wide initiative to digitize our products, most notably The Phia System™ and Case Management System.

Unwrapping the Benefits to Your Plan

On May 4, 2023
On January 1, 2022, the No Surprises Act (NSA) officially went into effect, affording protection to patients against surprise medical bills on certain types of claims, including out-of-network emergency services, ancillary out-of-network professional services rendered at in-network facilities, and air ambulance services. While the NSA has spared countless patients from potentially devastating balance bills, its complex and ever-evolving dispute resolution process has created headaches for plans and providers alike. Luckily, Phia Unwrapped includes NSA support services during the Open Negotiation period and, if necessary, Independent Dispute Resolution.

Empowering Plans: P161 – New Challenges to Old Favorites - NSA, ACA, and more (Acronyms)!

On April 28, 2023
In their latest podcast, Attorneys Nick Bonds and Corey Crigger are back to discuss the No Surprises Act (NSA) and the Affordable Care Act (ACA). Join them as they provide an overview of each of these laws and the recent legal challenges out of Nick’s home state of Texas. Will payment determinations resume? Has the ACA finally been struck down? Tune in to find out!

Before and After – Examples of Mistakes that Were Addressed and How to Avoid Them

On April 20, 2023
Accidents happen, but they aren’t all inevitable. Often, errors that lead to conflicts and costly outcomes could be avoided. Join The Phia Group’s team as they dig into real case studies, and share examples where The Phia Group was called upon to address some avoidable losses, as well as compare them to scenarios where the proper preemptive steps were taken. This April, remember what Benjamin Disraeli said: "The fool wonders; the wise man asks." Register today for this free and informative webinar!

Empowering Plans: P160 – How the Ending of COVID-era National Emergency Impacts Your Health Plan

On April 18, 2023
On April 10, President Joe Biden signed a bipartisan congressional resolution to terminate the U.S. national emergency in response to the COVID-19 pandemic—weeks before the development was supposed to occur in conjunction with a separate public health emergency expiring on May 11. Unsurprisingly, in the wake of such a stunning announcement, group health plans from coast to coast are scrambling to decide whether they must adjust their processes. In the latest Empowering Plan Podcast, Attorney Jennifer McCormick, Senior Vice President, Consulting, and Joanie Verinder, Director, Service Strategist, discuss the sudden end to the National Emergency, the many ways in which health benefit plans are affected, particularly in regards to timelines, and the information their respective participants need to be aware of.

The Phia Group's 2nd Quarter 2023 Newsletter

On April 13, 2023
The Phia Group is off to a great start in the second quarter of 2023! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

Marty Walsh Goes to Bat for NHL Retirees

On April 11, 2023
The National Hockey League’s collective bargaining agreement (“CBA”) is not set to expire until September of 2026, but it was still a hot topic during NHLPA Executive Director Marty Walsh’s introductory media conference last month in Toronto. In particular, there were several questions directed to the erstwhile Boston mayor and US Secretary of Labor about the union’s plans for managing the health benefits of retired players. Judging by his response, he didn’t appear to be blindsided.

Keeping PACE With COVID-19 Developments

On April 5, 2023
On January 30, 2023, the Biden administration announced its plan to terminate the national emergency and public health emergency declarations pertaining to the COVID-19 pandemic. Effective May 11, 2023, the phasing out of the public health emergency will mean a change in coverage requirements (i.e., vaccines administered out-of-network can involve cost sharing, no longer will there be free at-home COVID tests), while the end of the national emergency will affect the tolling of various health benefits related deadlines. The latter issue is one that resonates particularly strongly with The Phia Group’s PACE (“Plan Appointed Claim Evaluator”) service, whereby Phia manages final internal appeals, defends its decisions in the face of external appeal, and oversees the Independent Review Organization (“IRO”) external appeal process.

The Stacks – 2nd Quarter 2023 Newsletter

On April 4, 2023
This is "The Stacks" from The Phia Group's 2nd Quarter 2023 Newsletter

Empowering Plans: P159 – Putting the Patient First: Challenges to Common TPA Operations

On March 31, 2023
In this episode of The Phia Group's Empowering Plans podcast, attorneys Katie Malkin and Jon Jablon take a dive into three aspects of TPA operations designed to try to make the TPA's job more manageable: simplifying EOB denial codes, sending family EOBs, and recouping overpayments by offsetting. These are three common strategies used by TPAs, but applicable law places certain limits on all of them that are not always so intuitive. Tune in as Jon and Katie discuss some best (and worst) practices, and examine critical issues facing TPAs and health plans in today's self-funded industry.

Jimmy Carter’s Complicated Healthcare Legacy

On March 21, 2023
In the Bicentennial Summer of 1976—during which Jimmy Carter was campaigning for president—there was nonstop pageantry. Patriotism reached fever pitch as parade floats washed in red, white, and blue streamed through smalltown America while Uncle Sam-inspired merchandise flooded the shelves of department stores across the entire union. But overshadowed by the unprecedented amount of hoopla was the sobering reality that the then-two-century-old nation had a broken healthcare system: at this moment in time, 26 million Americans lacked health insurance altogether while another 28 million possessed only minimal coverage. And Carter, who grew up on a backwoods Georgia peanut farm with neither running water nor electricity, sympathized with the plight of the working poor by endorsing the concept that America needed universal healthcare coverage—to the extent that it was economically (and politically) feasible.

Empowering Plans: P158 – Seek and Ye Shall Find

On March 17, 2023
In the world of subrogation, there’s (almost) always more funds to recover, you just have to go searching for them—even if that means in unconventional places. In their latest podcast, attorneys Chris Aguiar and Cindy Merrell discuss how, particularly in regards to auto accidents involving participants who have substandard coverage, there is a heightened need to capitalize on opportunities for plans to recover funds. Don’t miss Phia’s veteran subrogation attorneys weighing in on how healthcare plans can be reimbursed so that their participants reap long-term benefits.