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Phia Group Media


Innovation at Its Finest- Cash Only Payment Model
By: Chris Aguiar, Esq.

I’ve had the honor and privilege of meeting Dr. Keith Smith and have worked with several benefit plans who have utilized his Center as part of their benefit offerings.  Dr. Smith is a true innovator in the cost containment space who genuinely cares about his patients and providing quality care at reasonable prices.  Read about his journey to a cash-only payment model.  Contact The Phia Group to find out how you can innovate and contain costs within your employee benefit plan.

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A Personal Experience- Self-funded Employee Benefit Plan
By: Adam Russo, Esq.

Yesterday, I posted a personal experience I had with the very first employee benefit plan I ever designed – my own. The Phia Group’s self-funded employee benefit plan is not just the plan my employees are on, it’s the plan my wife, four kids, and I are on. I pay a lot of attention to the experiences of our covered individuals so that we can make our plan better and in turn, the thousands of plans across the country that we represent. I woke up yesterday feeling pretty horrible so I went to an urgent care facility with whom we directly contract. The experience lasted 30 minutes. I had no co-pay and the generic drugs I needed had no co-pay as well.  The total cost to the plan was $250 for the visit and the prescription.

If I walked into a hospital emergency room the cost to the plan would have been $2400 and my out of pocket would have been $250. I wonder if I would still be in the waiting room. So many people have no idea that urgent care facilities are quality places with short waiting times and low costs. Educate your employees and incentivize them to want to lower the cost of healthcare.

Concerns about Health Care Coverage Mandates
By: Brady Bizarro, Esq.

One of the biggest unknowns of the Trump Administration’s health policy priorities is whether or not the new administration plans to repeal the individual and employer mandate. The White House has already directed federal agencies to “ease the burden” of ACA regulations on employers. Ditching the employer mandate would significantly change the landscape of employer-provided insurance, and it is something we will be watching closely.

LOA = Continuation of Coverage, or does it? One of the “Gap Traps”
By: Kelly Dempsey, Esq.

It’s intuitive to think that a leave of absence (LOA) from employment is coupled with a continuation of health plan coverage (CoC), especially if the leave is illness related; but to the dismay of many, a CoC isn’t always coupled with a LOA. Many employers struggle to align their plan docs with their EE handbook which increases the potential for a gap in stop-loss coverage. While most federal and state laws do not require a CoC, employers can provide the benefit of continued coverage – but if the employer wants stop loss to help out, the terms of CoC need to be spelled out in the plan doc.

Egregious Billing Hits the Common Man – Who Now Has a Place to Vent Their Frustration
By: Garrick Hunt

For those of us who are embedded in the health care industry, we know that the greatest issue with health care in America is the price tag. For the average American, health care is all about “what’s my out-of-pocket going to be?” Just recently a friend of mine, an average America to be sure, took to social media and went on a tangent about their bill. He was completely dumbfounded as he read through each line item…I laughed a little, unfortunately, this is the state of the industry.

Keeping the “Benefit” in Benefit Plans
By: Ron E. Peck, Esq.

Once upon a time, employers offered employees “benefit plans,” with an eye toward attracting and retaining a talented workforce.  The word – benefit – literally means something good; positive; of added value.  At some point, though, health insurance became less of a benefit and more of an entitlement.  At first it was an entitlement in theory, only, but more recently it became an entitlement according to law.  Next, between minimum value plans and high deductible plans, these so-called “benefit” plans became a point of contention – bad blood – between employers and employees.  Employers are increasingly frustrated with the rising cost of medical services and medication, as well as their employees’ perceived lack of concern or “skin in the game.”  Employees see co-pays and deductibles rising, and assume that greedy employers and “insurance companies” are looking to give them less, while expecting more from them.  When did we stop thinking of these plans as a “benefit?”  Fortunately, there are a few entities that still believe that “benefit” in “benefit plan,” has meaning, and are offering innovative ways to cut costs without reducing coverage – focusing on needs and avoiding worthless, wasteful endeavors.  From directing participants to use only the best, most cost effective providers, to rewarding them for spotting errors… from providing benefits that people actually need, and carving out high cost rarely needed services… by engaging providers in negotiation and direct contracting rather than blind faith on a third party’s efforts… we are all empowering plans, and returning the “benefit” to benefit plans.

The Big Elephant in the Room….
By: Michael Branco

From day one, over 16 years ago, we have offered overpayment recovery services, but over the last year, I have seen the largest growth in this service. It’s not enough to simply make a call or send a letter, and it’s okay to have that uncomfortable conversation with your client on why an overpayment occurred.  Ignoring the issue is no longer an option.

HIPAA Special Enrollment vs. Section 125 Permitted Election Change – There is a difference!
By: Jennifer McCormick, Esq.

An individual may want to adjust their health plan enrollment. For example, if a plan member’s spouse loses plan coverage due a reduction in hours it will likely trigger a HIPAA special enrollment under the health plan.  However, if that spouse discontinues their plan coverage because premiums increased a HIPAA special enrollment would not be triggered.   A permitted election change is separate, and would be outlined within the Section 125 cafeteria plan, not the health plan. HIPAA special enrollments and Section 125 permitted election changes do not necessarily overlap, and must be reviewed on a case by case basis.

Want to improve health care? Focus on hospitals
By Rich Lesser & Barry Rosenberg

(CNN) As Congress and the Trump administration debate the future of America’s health care system, they should go beyond the issues of access and cost and recognize an equally important priority: that patients come first, so health reform should also focus on quality of care.

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HHS nominee Dr. Tom Price’s 2nd confirmation hearing: 5 things to know
By Emily Rappleye

Rep. Tom Price, MD, R-Ga., faced another four hours of cross-examination Tuesday, this time with the Senate finance committee.

Grilled by Democrats and lauded by Republicans, Rep. Price’s second hearing comes ahead of a vote that will determine his nomination. The committee recessed and will reconvene to vote “promptly,” according to Sen. Orrin Hatch, R-Utah.

Here are five things to know about the second hearing.

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