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In-Network vs Out-of-Network Claims
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Mental Health Parity and Addiction Equity Act Explained
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The Insulin Cap Bill Offers Hope for Americans With Diabetes
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
The 2022 SIIA National Conference: What Lies Ahead for the Self-Funded Industry
On November 3, 2022
The SIIA National Conference, the world’s largest self-insurance industry event, resumed early last month at the JW Marriott Desert Ridge Resort and Spa in Phoenix, Arizona. The three-day event, which ran from October 9-11, covered a litany of timely topics, including a preview of the midterm elections (and impending regulatory changes); how evolving digital tools will enhance patient care; means by which insurance companies are accounting for emergent—and exorbitantly expensive—cell and gene therapies; the process by which captive insurance is countering “uninsurable” risk challenges; the multi-faceted relationship between TPAs and brokers; PBM business practices; far-reaching compliance matters such as the relationship between the No Surprises Act (NSA) and reference-based pricing (RBP) as well as the quest to obtain sufficient information for NQTL testing; and the booming growth of the medical stop-loss market in light of increasingly more U.S. employers transitioning to self-insurance.
RxDC Reports Are Almost Due – Make Sure You Are on Track for Compliance
On October 27, 2022
Our consultants have been receiving tons of questions in the last month about the upcoming Prescription Drug and Health Care Spending reporting (RxDC) requirements. The first two reports are due on December 27, 2022, for the 2020 and 2021 calendar years.
Empowering Plans: P147 – Transparency & More: Burning CAA/NSA FAQs
On October 27, 2022
In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jen McCormick and Jon Jablon bring up some of the most common questions that The Phia Group’s consulting team has been asked to field over and over again. From the so-called broker compensation rules to a TPA’s obligations related to a group’s No Surprises Act compliance, Jen and Jon highlight some of the main points to keep in mind when making important decisions regarding your business.
Book of Russo: Chapter 5
On October 21, 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, Mike Ferguson, President & CEO of the Self-Insurance Institute of America (SIIA), have to say about SIIA’s 2022 National Conference, the history of SIIA, and what to expect from SIIA in years to come.
The Witching Hour for Healthcare Plans
On October 20, 2022
Quite a few treats are in store for those tuning into The Phia Group’s next webinar, one that will cover some tricky topics. From breaking down regulatory changes impacting the healthcare industry (i.e., mental health parity, discretionary authority) to developments concerning plan drafting language, Phia’s roundtable of experts will keep you in the know. Oh, and did we mention that there’s also going to be a discussion of what to expect from a health policy standpoint in next month’s midterm elections?
The Phia Group's 4th Quarter 2022 Newsletter
On October 19, 2022
The Phia Group is off to a great start in the fourth quarter of 2022! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.
The Stacks – 4th Quarter 2022 Newsletter
On October 19, 2022
This is "The Stacks" from The Phia Group's 4th Quarter 2022 Newsletter
Empowering Plans: P146 - A Possible Threat to a Plan’s Discretionary Authority
On October 14, 2022
Currently before the Senate, a new bill has been announced that would ban all references to a plan administrator’s discretionary authority, as well as remove all deference courts give to their claims determinations. Regardless of whether this bill will be passed, what does this and similar rhetoric say about public and political attitudes towards self-funded health plans? Ron Peck, Chief Legal Officer, and attorney Kaitlyn MacLeod are here to talk about this and more. Enjoy!
Mental Health Matters Act: Why the MHPAEA Needs Reinforcement
On October 6, 2022
It was fourteen years ago this month that the Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law. The landmark piece of legislation had a profound impact on the healthcare industry, requiring group health plans and insurance companies to provide coverage for mental health/substance use disorder treatments in parity with medical services.
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.
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.
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