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Fourth Circuit Extends ADA Protection to Americans Suffering from Gender Dysphoria

On October 4, 2022
This August, the Fourth Circuit Court of Appeals in Williams v. Kincaid extended ADA protections to those suffering from gender dysphoria. The case related to the treatment of plaintiff Kesha Williams, a transgendered woman, while housed in a Virginia prison, but the holding has important implications in the workplace context.

Empowering Plans: P145 - Conflicting Views on COVID: Is the Pandemic “Over”

On September 29, 2022
Some strong statements about the COVID-19 Pandemic were made during President Biden’s 60 Minutes Interview that aired on Sunday, September 18, 2022. Join Kelly Dempsey and Kevin Brady in discussing those statements, the current status of the COVID-19 rules and plan language, and the rising numbers and costs related to COVID long-haulers.

Spending to Save for Quality Healthcare

On September 22, 2022
Learn how finding quality healthcare that may be more expensive month over month can save you money in the long run! Read more here!

Book of Russo: Chapter 4

On September 22, 2022
In the latest episode of The Book of Russo, tune in to find out what The Phia Group’s CEO, Adam Russo, and guest host, Dr. Jeffery Gold, have to say about Direct Primary Care and why Dr. Gold decided to open his own practice in Massachusetts.

Empowering Plans: P144 - The Latest Developments Involving Patient Assistance Programs

On September 16, 2022
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Andrew Silverio discuss patient assistance programs. They explain what these programs are, how they have been utilized in the industry, and the latest regulations and litigation surrounding them. Tune in to find out what plan sponsors need to know!

A Prescription for Success? The Unknown Impact of Recent Legislation on Prescription Expenses

On September 15, 2022
The Inflation Reduction Act, signed into law by President Biden last month, includes provisions to lower prescription drug prices for Medicare recipients. But what about most Americans who are on employer-sponsored plans? Could they be adversely affected by pharma companies potentially elevating prices in response? In its next webinar, The Phia Group takes a deeper dive into the residual effects of this landmark act on your plan—as well as how the recent Johnson & Johnson lawsuit involving patient assistance programs may heighten the risk for companies using such PAPs. For good measure, Phia’s panel of experts will also provide an update on final rules just released regarding the No Surprises Act.

Empowering Plans: P143 - Is Wrongful Death the Death of a Subrogation Claim?

On September 2, 2022
In this installment of the Empowering Plans podcast, attorneys Chris Aguiar and Cindy Merrell discuss the murky waters of wrongful death and healthcare subrogation claims.

Book of Russo: Chapter 3

On August 26, 2022
In the latest episode of The Book of Russo, tune in to find out what The Phia Group’s CEO, Adam Russo, and guest host, Ernie Clevenger, have to say about Ernie’s famous Saturday night newsletter, CareHere, and much more.

More Twists to the IDR Process in the No Surprises Act?

On August 25, 2022
The latest final rule on the No Surprises Act has finally been released by the U.S. Departments of Health and Human Services, Labor, and Treasury. There are some important clarifications made in this latest rule, including confirmation that the Qualifying Payment Amount (QPA) is no longer the presumptive out-of-network rate.

Empowering Plans: P142 - The (Healthcare) Times They Are A-Changin’

On August 19, 2022
In this installment of The Empowering Plans podcast, attorneys Nick Bonds and Corey Crigger discuss two recent shifts in the healthcare landscape: The FDA’s stance on OTC hearing aids and recent developments showing that not all debt is created equal, especially medical debt.

Unfinished Business: Legal Fallout Leaves Plans in Limbo

On August 18, 2022
Do you feel that Dobbs is already history? Does Build Back Better feel like old news? If so, think again! The domino effect of the Supreme Court’s recent decision is still raging across the country. Executive orders, legal challenges to state laws, and a deal to pass a massive healthcare bill should all be on your radar. The Phia Group is monitoring all of these developments in real time and in our new webinar we will reveal what you need to know to stay compliant.

Empowering Plans: P141 - Do You Mind (…The Gap)?!

On August 5, 2022
In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jen McCormick and Jon Jablon discuss the age-old topic of stop-loss gaps, with a modern twist. Emerging law and industry trends color so many decisions that self-funded plans and those who service them must make on a daily basis, and one player that sometimes gets forgotten about is stop-loss. Since stop-loss coverage expectations don’t always align with reality, health plans, TPAs, and brokers need to be proactive to find potential gaps and try to rectify them before they evolve into real problems.

Marietta Memorial Hospital Employee Health Benefit Plan v DaVita Inc. - Dialysis Carve-Out

On August 2, 2022
In one of last month’s momentous Supreme Court cases, Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., the justices confronted the legal question of whether the health plan covering employees of a small Ohio hospital contained a dialysis carve-out discriminating against participants with end-stage renal dialysis (ESRD). The Court, in a 7-2 decision, ruled that there was no such discrimination because the dialysis carve-out neutrally applied to all outpatient dialysis claims, not just those involving ESRD, and thus did not violate the Medicare Secondary Payer Act (MSP). While the Court’s ruling in favor of Marietta Memorial Hospital was surely a major victory for health plans implementing dialysis carve-outs, as well as plan sponsors, the contextual background to this case speaks to some critical underlying issues in the healthcare industry.

HHS Proposes Rules for 1557 Covered Entities

On August 1, 2022
On July 25, 2022, HHS announced a proposed rule that would strengthen the protections granted by Section 1557 of the ACA in various contexts. In line with the administration’s previous interpretations of the Supreme Court’s holding in Bostock v. Clayton County, HHS reinforces that 1557’s protections against discrimination based on “sex” extend to sexual orientation and gender identity.

Louisville Business First Names The Phia Group, LLC a 2022 Best Place to Work in Greater Louisville

On July 29, 2022
Read how The Phia Group was named the best place to work in greater Louisville. Learn more about The Phia Group and how they empower health plans.