Phia Group

Welcome to the Subrogation Sphere

On February 9, 2024
Las Vegas does not have the only sphere that can provide an extraordinary experience for its participants. Let me introduce you to the subrogation sphere where participants may first appear to have conflicting interests but can become allies. When a health plan member is injured because of a third-party action it sets into motion a dance involving many players, potentially including the plan participant, at-fault party, medical providers, stop loss carrier, and the health plan. Each player is trying to determine which player is the proper payor of the plan participant’s medical expenses.

Are Measles Making a Comeback | Key Insights and Impacts

On January 31, 2024
Discover the reasons behind the resurgence of measles, the impact on public health, and the urgent need for increased vaccination rates among children.

A New Year Brings New (Higher) Prescription Drug Prices

On January 18, 2024
It must be January. W-2 forms are hitting the mail. Fitness centers are packed to the brim. The NFL playoffs are in full force.

Understanding Gender-Affirming Care Exclusions in Plans

On January 16, 2024
Explore the complexities of gender-affirming care exclusions in health plans, including legal considerations, compliance issues, and potential discrimination risks.

Understanding Cross-Plan Offsetting & DOL's Recent Actions

On January 3, 2024
Explore the implications of cross-plan offsetting in healthcare, including the DOL's recent action against EmblemHealth for violating fiduciary duties.

Time’s Up! It’s Gag Clause Attestation Season

On December 26, 2023
As the year wraps up and plans and TPAs around the country are scrambling to handle renewals, another challenge looms large in 2023 – the first annual gag clause attestation. As a reminder, the Consolidated Appropriations Act, 2021 (CAA) prohibits plans from entering into any contracts with providers and certain other entities that contain “gag clauses” – and requires them to attest annually that their contracts are free of them. The first attestation is due at the end of 2023, and it will cover the period of December 27, 2021 through December 31, 2023. The goal of the legislation is transparency, but it has glaring holes – contracts can’t prohibit plans from sharing certain information with other entities, but nothing requires them to be granted access to this information in the first place.

Sickle Cell Disease Treatments | Cost of Casgevy & Lyfgenia

On December 21, 2023
Learn about the groundbreaking treatments for sickle cell disease, including Casgevy and Lyfgenia, and the financial implications for patients and health plans.

AI in Healthcare | Revolutionizing Patient Care and Access

On December 12, 2023
Learn about the potential of AI to transform healthcare delivery, enhance patient outcomes, & streamline administrative tasks, along with the associated risks.

Being Mindful of Telemedicine Access

On November 9, 2023
From a healthcare standpoint, two of the most significant byproducts of the COVID-19 pandemic have been the exploding popularity of Telemedicine, the practice of providing medical and mental health services remotely, and a heightened awareness of many Americans’ longstanding mental health issues. Due to a confluence of prolonged extenuating circumstances, it became readily apparent to healthcare providers, politicians, social workers, employers, teachers, and parents on both sides of the Mississippi that a.) the inimitable convenience of virtual healthcare does not compromise quality (at least for some patients and practitioners) and b.) many Americans experiencing emotional distress have long been suffering in silence.

Update on the Federal IDR Process

On October 27, 2023
Recently there has been significant discussion about the federal IDR process. The IDR process is an important tool of the No Surprises Act (“NSA”) as it resolves claims for payment for out-of-network items and services. It not only provides a procedure for settling disputed claims but is also an integral mechanism for supporting the NSA’s protection for plan members against potentially crippling expenses from balance billing for high-cost out-of-network claims.

Empowering the 2023 SIIA National Conference

On October 26, 2023
Earlier this month, the self-insurance industry’s most prominent thought-leaders, innovative service providers, and esteemed subject matter experts convened at the 2023 Self-Insurance Institute of America (SIIA) National Conference at the JW Marriott Phoenix Desert Ridge Resort & Spa. The SIIA National Conference, which this year covered such pressing topics as artificial intelligence, surprise billing, emerging trends impacting the employer stop-loss market, and recent legislative and regulatory updates, is widely considered to be the self-insurance industry’s annual marquee event, bringing together hundreds of industry professionals including TPAs, vendors (there were over 950 booths representing industry vendors stationed in the exhibitor hall), brokers, captive managers, stop-loss carriers, and solution providers.