Phia Group

Empowering Plans: P206 – Non-Preferred Carrier Fees: Incentives or Control?

On December 5, 2024
In this episode of the Empowering Plans podcast, attorneys Jon Jablon and Brady Bizarro delve into the details of a recent lawsuit where BCBS of Michigan, in its capacity as a TPA, is alleged to have engaged in anticompetitive practices for charging a fee to a group that chose a stop-loss carrier other than BCBS. This case is in its infancy as of December 2024, but we expect it to have noticeable effects on the stop-loss marketplace regardless of outcome. In this episode, Jon and Brady discuss those potential effects and how a holding either way could impact self-funding as a whole.

Health Disparities in Appalachia After Hurricane Helene

On December 2, 2024
Explore the widening health disparities in Appalachia following Hurricane Helene, highlighting the challenges faced by residents and healthcare facilities.

Understanding New MHPAEA Requirements for Compliance

On November 20, 2024
Understand the implications of the new MHPAEA rules, including NQTL requirements & the importance of conducting comparative analyses for mental health benefits.

A New Year, a New Administration, but the Same Old Problem?

On November 19, 2024
On Friday, November 1, millions of Americans awoke from their Halloween slumber only to be further spooked by a New York Times report that employers expect the costs of health benefits to surge as much as 9 percent on average in 2025. How much will the outcome of this month’s elections – held during many companies’ open enrollment period -- impact this now decades-long industry trend? What does this all mean for plans interested in covering big-ticket items like weight loss drugs and next-generation gene therapies in the new year? As 2024 soon merges into 2025, join The Phia Group’s webinar as its panel of experts break down how election results will impact the industry and look ahead to what compliance changes are afoot in just over a month ahead. Indeed, this is a crucible moment for the healthcare industry – and Phia’s Independent Consultation & Evaluation (ICE) team looks forward to lending its expertise.

Addressing Balance Billing and Payment Disputes for TPAs

On November 14, 2024
Discover best practices for TPAs and self-funded employers to address balance billing and post-payment disputes, enhancing compliance and member support.

Empowering Plans: P205 – Lessons From a Florida IDR Case

On November 5, 2024
On this episode of the Empowering Plans Podcast, attorneys Ron Peck and Nick Bonds talk through a recent Florida case addressing judicial review of IDR determinations and highlight some of the key insights and takeaways for any entity subject to the No Surprises Act.

Having NSA Problems? Better Call The Phia Group

On October 31, 2024
The Independent Dispute Resolution (“IDR”) process was designed to be a cornerstone of the No Surprises Act (“NSA”), a means for resolving claims for payment for out-of-network items and services and a vital mechanism for buttressing the NSA’s protection for plan members against potentially devastating balance billing expenses. Unfortunately, since the NSA took effect on January 1, 2022, things have gone awry on many fronts.

The Future of Birth Control in America

On October 28, 2024
Since the US Supreme Court decided to undo nationwide abortion rights in summer 2022, women’s reproductive rights has arguably been the most pressing topic in healthcare. Naturally, as we enter the final stretch of election season – as well as the Biden administration – the all-important, polarizing matter has resurfaced.

Empowering Plans: P204 – Nightmares on Self-Funded Street

On October 24, 2024
Join Attorneys Corey Crigger and Kendall Jackson on this Halloween edition of the Empowering Plans Podcast. Corey and Kendall take a look at topics that send shivers down the spine of the self-funded industry. How do you protect your plan from the scary cost of gene therapies? What will the rapidly advancing AI sector mean for you and your clients? What is the best trick or treat candy? Tune in to find the answers to these questions and many more on the Empowering Plans Podcast.

Industry Crossroads – How the 2024 Election Impacts You & Major Implications For Our Industry

On October 17, 2024
Although healthcare hasn’t stolen the limelight as it did in past elections, those “in the know” know that the results of this historic election will have a major impact on healthcare and health benefit plans alike. Between soaring drug costs, increased fiduciary litigation, the impact of A/I, and growing popularity of weight-loss drugs (which is likely to escalate as the year ends), to thrive in 2025 and beyond industry insiders must understand the current state of the market as well as predict what is to come. Join us as we discuss these and other pressing issues. Also, speaking of A/I, our team will present a live demonstration of SoPhia, our very own chatbot, which will engage with audience questions.

The Phia Group's 4th Quarter 2024 Newsletter

On October 16, 2024
The Phia Group is off to a great start in the fourth quarter of 2024! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

Empowering Plans: P203 – Gender-Affirming Care, Is it Covered?

On October 15, 2024
On this episode of the Empowering Plans Podcast, attorneys Jon Jablon and Cindy Merrell explore the changing landscape of several state and federal laws that affect coverage of gender-affirming care.

Cobenfy: A Game-Changer for Schizophrenia Treatment Costs

On October 9, 2024
Cobenfy is a promising new drug for schizophrenia. Find out about its cost, insurance coverage, and how it compares to existing treatment options.

Healthcare and Politics… Ugh. Old News!

On September 27, 2024
Donald Trump recently stated that while he will never give up on repealing the ACA, he also said that he was not running on terminating the ACA. This is likely a smart decision, given that a recent Kaiser Family Foundation (KFF) poll revealed that for Republican voters, repealing Obamacare was an important issue for a very small percent of respondents. Is this demonstrative of a more widespread loss of interest in health care as a political talking point?

Empowering Plans: P202 – Senator Sanders: “Stop ripping us off.”

On September 26, 2024
Attorneys Brady Bizarro and Andrew Silverio discuss the recent senate committee hearing on GLP-1 drug pricing and strategies that self-funded employers are using to manage the extreme costs of these drugs while we wait and hope for congressional action.