Phia Group

Empowering Plans: P199 – Summer Regulation Rundown

On August 29, 2024
The regulators rush to finalize a suite of marquee regulations as the clock gradually runs out on the Biden administration. Even when finalized, these regulations may be vulnerable in the post-Chevron landscape. Attorneys Kelly Dempsey and Nick Bonds pick apart some of the big rules we’re looking forward to and the challenges they may face.

Healthcare in Rural America | Overcoming Access Barriers

On August 19, 2024
Explore the significant barriers to healthcare access in rural America, including resource scarcity, long distances to facilities, & low health literacy rates.

Don't Be Surprised - Phia's Keys to Success with The No Surprises Act and Appeals Management

On August 19, 2024
As the dog days of summer drag on, the No Surprises Act and its benefactors are feeling the heat. Case volume is overloading the IDR process. Courts are split over whether and how parties can enforce arbitration awards. Payers, including group health plans, are paying nearly four times as much for services as CMS. Combined, this all threatens to undermine the original intent of the law and drive up costs for all. Now, more than ever, it is paramount to understand how these developments impact you and to enact a process to triage billing disputes - separating NSA claims from appeals. Phia is the option for success in this arena. Join our legal team on Tuesday, August 20th, at 1:00 P.M. ET, as we discuss our unique, battle tested processes for handling NSA claims and appeals. From utilizing intelligent out-of-network pricing methodologies and benchmarking to deploying cutting edge appeal review software, we cover all the bases and reveal the best practices for success.

Empowering Plans: P198 – Healthcare on the Ballot

On August 15, 2024
Nick Bonds and Corey Crigger are hosting this political edition of the Empowering Plans Podcast series. With an election looming in November, Nick and Corey take a look at the policies and agendas from the Harris/Walz and Trump/Vance tickets. They discuss the impact that each administration could have on the self-funded industry and the country, in the most civil political discourse you can find. Tune in to hear what each nominee has to say about: Medical Debt, the Opioid Crisis, Public Healthcare options, and more!

Health Over Wealth Act | Protecting Patients from PE Firms

On August 5, 2024
Learn about the Health Over Wealth Act, designed to hold private equity firms accountable in healthcare, ensuring patient welfare is prioritized over profits.

Empowering Plans: P197 – The Concerns About PBMs and the Demand for Reform

On August 1, 2024
In this episode of the Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson break down the consequences of PBM steerage. Join us in the discussion of the Federal Trade Commission’s inquiry into PBM practices and the push for legislation to increase transparency in the market and hold PBMs accountable.

The Phia Group's 3rd Quarter 2024 Newsletter

On July 30, 2024
The Phia Group is off to a great start in the third quarter of 2024! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

What the Overturning of Chevron Means for Healthcare

On July 19, 2024
For the past forty years, federal agencies have had considerable latitude to interpret and enforce regulations and subsequently advance regulatory initiatives. Per the precedent established in the Supreme Court’s 1984 decision in Chevron U.S.A., Inc. v. Natural Resources Defense Council, courts have had to defer to federal agencies regarding legal challenges over ambiguously written laws passed by Congress. The rationale was as follows: The public servants employed by the federal agencies, whether they be scientists, engineers, law enforcement officials, economists, or experts in another field, have more specialized expertise in the given matter – even more so than Supreme Court justices -- and should thus be accountable for implementing the law. But effective late last month, the High Court, believing that unelected government officials should not wield such tremendous influence, overturned that precedent, thus yielding unprecedented power to the courts to use their own discretion in interpreting laws – many of which pertain to the country’s healthcare ecosystem.

Empowering Plans: P196 – Exploring Claims Processing Models

On July 18, 2024
On this episode of the Empowering Plans Podcast, attorneys Andrew Silverio and Cindy Merrell delve into the pros and cons of the pay and chase versus pend and pay models of claims processing. They provide an in-depth discussion on the coordination of benefits and the timing of claims processing when another party may be responsible for payment.

The Impact of Provider Trends on Stop-Loss and Plans

On July 16, 2024
We progressively find ourselves on the receiving end of both medical provider and legislative efforts to secure more funding from payers. As costs increase, overpriced treatments gain popularity, and fallout from new laws continues to do more harm than good; things aren’t getting less expensive. Stop-loss carriers – responding to these trends – are circling the wagons and implementing new protective measures … but at what cost? Join The Phia Group as they discuss how to counterbalance rising prices as well as navigate these increasingly complex interactions with stop-loss.

Empowering Plans: P195 – SCOTUS Decisions: Harrington and Loper's Impact on Healthcare

On July 2, 2024
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Corey Crigger break down two of the most significant Supreme Court cases just decided this term – the Harrington case (rejecting the largest opioid settlement in the country) and the Loper case (in which the Supreme Court ended Chevron deference). How will these cases impact the healthcare landscape? What should self-funded plans and their partners know moving forward? Tune in to hear our expert analysis.

Impact of Supreme Court on Gender-Affirming Care Bans

On June 26, 2024
Explore the implications of the Supreme Court's hearing of the challenge against state bans on gender-affirming care for minors & its impact on healthcare.

Direct Contracting and Occam’s Razor

On June 21, 2024
Maybe I should be, but I’m not ashamed to admit that when I first heard of Occam’s Razor, I assumed it had something to do with shaving. Whatever the context, many know Occam’s Razor as a principle of decision-making holding that “the simplest explanation is the best one”. Although the real idea is similar, William of Ockham’s logic is a bit more formulaic than that. To paraphrase, Occam’s Razor suggests that when choosing between multiple options, the best choice is the one that requires the fewest assumptions to reach. Put another way, the best option is the one that has the highest likelihood of actually being the case, by requiring the fewest assumptions to achieve it.

Empowering Plans: P194 – The Rapid Evolution of the Pregnant Workers Fairness Act

On June 20, 2024
Just like the development of a child, regulations evolve in their ability to walk and talk over time. Join Jen McCormick and Kelly Dempsey as they go through the evolution of the Pregnant Workers Fairness Act – from passage in late 2022 to the final rules that took effect on June 18, 2024. They also discuss current court challenges where two courts have reached opposite conclusions and, of course, what this all means for self-funded health plans. It’s hard to keep up as this one went from crawling to running in fewer than two months!

Section 1557 Final Rule | Key Implications for Health Plans

On June 17, 2024
Explore the implications of the Section 1557 Final Rule, which strengthens civil rights protections in healthcare, including access to telehealth services.