Phia Group

The Phia Group Introduces its Phia Ignite Repricing Engine: A Game-Changer in Cost Containment

On June 14, 2023
Read about The Phia Group's new Phia Ignite Repricing Engine. Learn how Phia Ignite will strengthen our efforts to empower plans.

Empowering Plans: P164 – The Key to a Successful Self-funding Experience: Knowledge!

On June 9, 2023
With many self-funded employers entering the field from a world where their benefits are “set it and forget it,” educating plan sponsors about their obligations, relationships, opportunities, and risks is often the difference between retaining and losing a client. Attorneys Andrew Silverio and Christopher Aguiar muse about the challenges arising when self-funded plans aren’t educated about their benefit offerings, the risk mitigation mechanisms, and the cost containment tools being utilized to ensure the plan’s viability.

A Weight Off My Chest

On June 6, 2023
Insurance is supposed to be something you purchase to protect yourself against unforeseen – but costly – losses. You don’t “expect” to be involved in a motor-vehicle accident, but you purchase automobile insurance to protect yourself against the costs incurred in an accident. You don’t expect your home to flood or burn down, but you purchase homeowner’s insurance to protect yourself against the costs incurred in such incidents. Automobile insurance does not pay to fill your car’s gas tank or change the oil. These are foreseen, planned costs of automobile ownership and maintenance. Homeowner’s insurance does not pay to replace the filters in your HVAC or power wash mold from the siding. These are foreseen, planned costs of home ownership and maintenance. Why, then, does health insurance pay for foreseen, planned costs of your body’s maintenance? More importantly, how have recent trends taken advantage of our addiction to health insurance, and the expectation that it will pay for everything?

Autism Benefits: DOL Enforcement for Sufficient Coverage

On May 22, 2023
About 1 in 36 children in the United States has autism spectrum disorder, which is a lifelong condition that can affect a person’s behavior, communication, interactions, and ability to learn. The Department of Labor (DOL) continues strongly advocating for more comprehensive autism coverage under group health plans and Employee Benefits Security Administration (EBSA) has been working to ensure individuals who need treatment are able to access it. The Phia Group is also working hard to ensure plans are offering robust benefits while remaining compliant with mental health parity laws.

Empowering Plans: P163 – ChatGPT: Disrupting the Healthcare Industry

On May 19, 2023
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O'Hara provide an overview of ChatGPT, the artificial intelligence chatbot developed by OpenAI, and describe how it is disrupting the healthcare industry. In particular, they focus on one emerging use for the technology - acting as a virtual assistant for patient care. What are the advantages of using AI in this manner? What are the concerns? Tune in for what will be a topic that we revisit in the coming weeks and months!

The Business of Benefits

On May 18, 2023
Those who service health benefit plans are usually focused on delivering the most robust coverage for the least cost. Yet, all too often we forget that our industry, like any other, only thrives when our own businesses prosper. From adjustments to a post-pandemic environment (and employee populations working remotely from numerous locations), to conflict resolution between entities (such as disputes between plans, stop-loss, and TPAs over reimbursement of fees for savings and management of the NSA), join The Phia Group as we discuss the current events and case studies that will impact whether your own organization sinks or swims.

Empowering Plans: P162 – Mind the Gap 2.0: Don’t be Afraid to Ask for a Handbook

On May 12, 2023
In this episode of Empowering Plans, Kelly Dempsey and Kevin Brady outline the relevant details provided within our Handbook Gap Free Reviews. They provide a description of the service, the case studies which gave rise to this service and describe why a review of the Handbook is more important now than ever before!

Digitizing Subrogation

On May 10, 2023
When it comes to subrogation, The Phia Group has over 20 years’ experience serving clients nation-wide. Our attorneys are some of the industry’s most well-versed subrogation experts who can relate to a wide swath of health plans – from self-insured to Medicare-based ones. But we know there can be a great deal of attrition and stiff competition in the subrogation space, which is why for the better part of the past decade there has been a company-wide initiative to digitize our products, most notably The Phia System™ and Case Management System.

Unwrapping the Benefits to Your Plan

On May 4, 2023
On January 1, 2022, the No Surprises Act (NSA) officially went into effect, affording protection to patients against surprise medical bills on certain types of claims, including out-of-network emergency services, ancillary out-of-network professional services rendered at in-network facilities, and air ambulance services. While the NSA has spared countless patients from potentially devastating balance bills, its complex and ever-evolving dispute resolution process has created headaches for plans and providers alike. Luckily, Phia Unwrapped includes NSA support services during the Open Negotiation period and, if necessary, Independent Dispute Resolution.

Empowering Plans: P161 – New Challenges to Old Favorites - NSA, ACA, and more (Acronyms)!

On April 28, 2023
In their latest podcast, Attorneys Nick Bonds and Corey Crigger are back to discuss the No Surprises Act (NSA) and the Affordable Care Act (ACA). Join them as they provide an overview of each of these laws and the recent legal challenges out of Nick’s home state of Texas. Will payment determinations resume? Has the ACA finally been struck down? Tune in to find out!

Before and After – Examples of Mistakes that Were Addressed and How to Avoid Them

On April 20, 2023
Accidents happen, but they aren’t all inevitable. Often, errors that lead to conflicts and costly outcomes could be avoided. Join The Phia Group’s team as they dig into real case studies, and share examples where The Phia Group was called upon to address some avoidable losses, as well as compare them to scenarios where the proper preemptive steps were taken. This April, remember what Benjamin Disraeli said: "The fool wonders; the wise man asks." Register today for this free and informative webinar!

Empowering Plans: P160 – How the Ending of COVID-era National Emergency Impacts Your Health Plan

On April 18, 2023
On April 10, President Joe Biden signed a bipartisan congressional resolution to terminate the U.S. national emergency in response to the COVID-19 pandemic—weeks before the development was supposed to occur in conjunction with a separate public health emergency expiring on May 11. Unsurprisingly, in the wake of such a stunning announcement, group health plans from coast to coast are scrambling to decide whether they must adjust their processes. In the latest Empowering Plan Podcast, Attorney Jennifer McCormick, Senior Vice President, Consulting, and Joanie Verinder, Director, Service Strategist, discuss the sudden end to the National Emergency, the many ways in which health benefit plans are affected, particularly in regards to timelines, and the information their respective participants need to be aware of.

The Phia Group's 2nd Quarter 2023 Newsletter

On April 13, 2023
The Phia Group is off to a great start in the second quarter of 2023! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

Marty Walsh Goes to Bat for NHL Retirees

On April 11, 2023
The National Hockey League’s collective bargaining agreement (“CBA”) is not set to expire until September of 2026, but it was still a hot topic during NHLPA Executive Director Marty Walsh’s introductory media conference last month in Toronto. In particular, there were several questions directed to the erstwhile Boston mayor and US Secretary of Labor about the union’s plans for managing the health benefits of retired players. Judging by his response, he didn’t appear to be blindsided.

Keeping PACE With COVID-19 Developments

On April 5, 2023
On January 30, 2023, the Biden administration announced its plan to terminate the national emergency and public health emergency declarations pertaining to the COVID-19 pandemic. Effective May 11, 2023, the phasing out of the public health emergency will mean a change in coverage requirements (i.e., vaccines administered out-of-network can involve cost sharing, no longer will there be free at-home COVID tests), while the end of the national emergency will affect the tolling of various health benefits related deadlines. The latter issue is one that resonates particularly strongly with The Phia Group’s PACE (“Plan Appointed Claim Evaluator”) service, whereby Phia manages final internal appeals, defends its decisions in the face of external appeal, and oversees the Independent Review Organization (“IRO”) external appeal process.