The Replacements

On April 8, 2016
As the self-funded industry evolves, benefit plans are forced to evolve with it or get left in the dust. Employees need quality coverage – but providing robust yet affordable programs has proven difficult for many self-funders. This conundrum can be addressed by changing inefficient or archaic processes; in response to contractual handcuffs limiting your ability to target cost drivers, too many health plans and TPAs overreact, thinking that the solution is to trash their plan entirely, and to try something new and untested – trading security for savings. When it comes to benefits, don’t remove, don’t reduce... replace! Avoid the extreme sides of the spectrum, achieve balance, and ensure your own viability with “The Replacements.” Thank you for joining The Phia Group on Tuesday, February 16th, as we identified the trouble spots found in all benefit plans, and helped develop strategies to carve them out and replace faulty portions with new alternatives – without harming the rest of the plan!

Sky-Rage: Bills, Debt, Lawsuits Follow Helicopter Medevac Trips

On March 18, 2016
The helicopter ambulance that rushed Shauna Laswell to a Las Vegas hospital after a heart attack may have saved her life. Read More.

TPA of Self-Insured Health Plan Not Subject to Texas Prompt-Pay Law

On February 24, 2016
The Fifth Circuit has ruled that a third-party administrator (TPA) of employer-sponsored self-insured health plans is not an insurer subject to the Texas Prompt Payment Act.

The Top 10 Lessons of a Reference Based Pricer

On February 16, 2016
Where to gather to discuss reference based pricing (RBP), you will have three opinions.

Montanile Changes Subrogation – How Will You Respond?

On January 27, 2016
On January 20, 2016, The Supreme Court of the United States decided in favor of the plan participant in the case of Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan

ERISA Plan Cannot Recover Settlement Funds That Have Been Spent

On January 25, 2016
The U.S. Supreme Court has narrowed, ever so slightly, the ever-changing definition of “appropriate equitable relief” under ERISA Section 502(a)(3).

How to Proactively Manage Self-Funded Employer Health Plans Recommendations by a Hospital Legal Advisor

On January 25, 2016
As more patients join self-funded plans, hospitals face new challenges regarding billing and collection. The increase in self-funded employer health plans has triggered an unintended consequence for hospitals with respect to payment for services.

Saving Stop-Loss - Protecting a Key Self-Funding Ingredient in a Hostile World

On January 19, 2016
Thank you for joining The Phia Group’s legal team on Tuesday, January 19, 2016, as they provided first-hand insight into the self-funded market’s reliance on stop-loss and threats to that industry, including what TPAs and brokers should look for – and look out for – when advising health plan sponsors regarding stop-loss options.

Secrets to Making Reference-based Pricing Work

On January 18, 2016
Employers, administrators, brokers and courts have begun to realize that determining the value of a health care service must involve something more than considering only a provider’s billed charges.

Anti-Assignment Clauses Bar Provider’s ERISA Claims

On January 7, 2016
An out-of-network health-care provider can’t continue with her claims under the Employee Retirement Income Security Act for unpaid benefits, fiduciary breach and failure to disclose documents against four health benefit plans, the U.S. Court of Appeals for the Eleventh Circuit ruled.

Issue of the Year: Reference-Based Pricing and Balance-Billing

On December 28, 2015
Thank you for joining The Phia Group’s legal team on December 15th as they discussed reference-based pricing and balance-billing from the ground up and debunked common myths associated with it. This webinar will ended the year with a comprehensive primer on reference-based pricing and balance-billing, the rights of all parties involved, and what you can do to be proactive and successfully administer a reference-based pricing program.

Court Nixes Health Plan’s Subrogation Claim

On December 23, 2015
A health plan isn’t entitled to reimbursement of $48,000 in medical expenses it paid on behalf of a minor beneficiary who was injured in an all-terrain vehicle accident

Less Takes More - The Phia Group Addresses the Summary of Benefits & Coverage Requirement

On December 22, 2015
Benjamin Franklin, Blaise Pascal, and Mark Twain are all credited with having said, “I would have written a shorter letter, if I’d had the time.” Unfortunately, efforts to simplify complex matters often constitute the greatest challenge. This fact of life is certainly proven by the Affordable Care Act and its requirement that health plans provide consumers with a concise document detailing, in plain language, information about plan benefits and coverage. This summary of benefits and coverage document ( or “SBC”) is meant to help consumers better understand the coverage available to them, and allow them to easily compare options by summarizing key features such as the covered benefits, cost-sharing provisions, coverage limitations and exceptions.

Keeping PACE With The Trends

On December 7, 2015
Thanks for joining The Phia Group’s legal team on November 30th as we explored the numbers behind our industry’s growth and provided real-world discussion on the topic, while we explored real solutions to the issues presented.

The Supreme Court Seeks Solutions to the Latest Challenges to Subrogation Rights in Montanile Case

On December 4, 2015
The facts of the latest healthcare subrogation challenge on the SupremeCourt’s docket will be familiar to many.