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In-Network vs Out-of-Network Claims
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Mental Health Parity and Addiction Equity Act Explained
Understanding Non-Quantitative Treatment Limitations (NQTLs)
The Insulin Cap Bill Offers Hope for Americans With Diabetes
In-Network vs Out-of-Network Claims
Gag Clause Prohibition Compliance Attestation
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Matt Painten
Matt Painten's Blog
Empowering Plans: P157 – New TPA Liabilities – Section 1557
On March 3, 2023
One of the healthcare trends we have been following so far in 2023 is expanded TPA liabilities. In this edition of the Empowering Plans podcast, attorneys Brady Bizarro and Andrew Silverio discuss a recent federal court case in which a TPA was found liable for violations of the ACA’s Section 1557. Despite numerous defenses raised by the TPA, many of which we see regularly used by TPAs, the court rejected them all, potentially expanding the scope of Section 1557. Tune in to hear more about this significant case and what it means for our industry.
Hospital Prices: Fully Transparent or Still Somewhat Opaque?
On February 23, 2023
In the throes of the first pandemic winter, still months before coronavirus vaccines would roll out in earnest, the Hospital Price Transparency Rule went into effect. It was a promising development in the world of healthcare cost containment—hospitals were now obligated to provide a single, machine-readable digital file containing standard charges for all services and items provided by the facility.
Empowering Plans: P156 – Accommodating Reasonably: Navigating the ADA and PWFA in 2023
On February 16, 2023
On this episode of Empowering Plans, Kelly Dempsey and Kevin Brady provide some valuable insights into the reasonable accommodation process under the ADA and PWFA. The PWFA, which will be effective this June, expands the scope of existing federal law with respect to accommodating employees with known limitations related to pregnancy, childbirth, or related medical conditions. Tune in to learn why this is important for employers in 2023 and beyond!
The State of Paid FMLA: Thirteen States and Counting
On February 15, 2023
Crucial healthcare and employee benefits issues were addressed during President Biden’s recent State of the Union, including a commitment to expanding paid family and medical leave. Thirty years ago, the Family and Medical Leave Act (FMLA) was passed and created new opportunities for employees faced with the difficult decision of having to choose between work and family. FMLA allows eligible employees to take unpaid, job-protected leave for family and medical reasons and continue their group health coverage.
Love is in the (Health)Care!
On February 15, 2023
Roses are red, violets are blue, and The Phia Group has some hot tips for you. Whether you sponsor, administer, or service self-funded health plans, The Phia Group’s free webinar will thrill and amaze you. The Phia Group’s team presented a variety of important issues, best practices, and case studies. From disputes with providers, to subrogation, to regulatory updates, and beyond… this webinar is better than a box of chocolates. Don’t wait to unwrap your gift!
Empowering Plans: P155 – The State of the Union 2023: Phia’s Take
On February 10, 2023
The State of the Union has always served as an important bellwether for our country, but also, for our industry, revealing what the current administration’s healthcare policies will be going forward, and in some cases, which ones enjoy bipartisan support. In this special edition podcast, join attorneys Ron Peck and Brady Bizarro as they break down the president’s speech, providing you with their reaction and analysis, and explain what you should be watching this year.
SPD Payment Limitations Under the No Surprises Act
On February 9, 2023
Ah, the Plan Document! It’s the “supreme law of the land” governing the health plan’s benefits. Would that make ERISA the Declaration of Independence of self-funding, maybe? Freedom from the tyranny of state or federal laws that attempt to make their own rules for the plan rather than letting the plan govern itself?
Empowering Plans: P154 – No Ordinary Time in Healthcare
On February 3, 2023
Corey Crigger and Nicholas Bonds cover a lot of ground in the newest installment of The Phia Group’s Empowering Plans podcast: Whether it’s the National and Public Health Emergencies starting to wind down or what state legislatures have in store for non-profit hospitals that overcharge or Amazon creeping into the healthcare space, Phia’s attorneys are here to keep you up to date on the ever-changing world of healthcare.
Are Non-Competes Out the Window?
On February 2, 2023
Not just yet. Recently, the Federal Trade Commission (FTC) proposed a new rule that would ban post-employment non-competition agreements for all workers, including independent contractors, in nearly all workplaces. The proposed rule falls under Section 5 of the Federal Trade Commission Act, which bans unfair methods of competition. This proposed rule would greatly impact the entire healthcare industry.
The Phia Group Is Proud to Announce That Ujwal Shrestha and Caitlin Lankston Have Joined Their Team
On January 31, 2023
Read about Ujwal Shrestha joining The Phia Group as VP, Business Analytics and Data Services, and Caitlin Lankston joining The Phia Group as a Senior Data Scientist. Learn how Ujwal and Caitlin will strengthen their efforts to empower plans.
Robotic Lawyers – the Future of Small Claims Courts?
On January 24, 2023
A couple months ago, Forbes magazine published a story hypothesizing five professions that could be eliminated by Artificial Intelligence over the next decade: factory workers, couriers, investment analysts, customer service reps, and security guards. It sounds farfetched, but could “small claims attorney” also join the dreaded list in the not-too-distant future? An intrepid startup, DoNotPay, which bills itself as “the world's first robot lawyer,” has designs on such a development—and perhaps even bigger things—coming to fruition.
No Matter the Remedy – No Language, No Luck!
On January 23, 2023
Recently, the 9th Circuit, a jurisdiction that has historically not been kind to benefit plans engaging in third party recovery activity, issued a decision that gives life to benefit plans whose participants shirk their obligations to reimburse their benefit plans from settlements they obtain in third-party liability cases.
Empowering Plans: P153 – Living Up To Expectations
On January 20, 2023
Over the last decade, The Phia Group’s leaders have made quite a few predictions. There have been some hits and misses. Join attorneys Ron Peck and Jen McCormick as they discuss past predictions, their predictions for 2023, and what the best health plans need to do to stay ahead of the game this year!
An Omnibus Edition to Kick Off 2023
On January 19, 2023
It’s only January, but 2023 already promises to be a momentous year in healthcare law. From the recent passage of The Consolidated Appropriations Act of 2023—and its inclusion of protections for pregnant and nursing mothers—to regulatory updates regarding the No Surprises Act and manufacturer assistance programs, there’s quite a bit to break down as the new year unfolds. Join The Phia Group’s panel of experts as they discuss how such sweeping changes will impact your group’s health plan.
Accommodating Pregnant Workers: Enhanced Protections Under New Legislation
On January 18, 2023
On December 29, 2022, President Biden signed the Consolidated Appropriations Act of 2023 (CAA 2023). Among many, many other things, the CAA included a key law expanding protections for pregnant workers. This law addresses significant limitations in the current regulatory framework for these workers, particularly under the Americans with Disabilities Act (ADA) which does not consider pregnancy a covered disability, and the Pregnancy Discrimination Act (PDA) which does not require accommodation (beyond those afforded to other similarly situated employees).
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