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Empowering Plans Segment 01 - The Maiden Voyage
Welcome to the maiden voyage of "Empowering Plans," a new Podcast by The Phia Group where our hosts will review the purpose of this new series of Podcasts, reveal what the next few episodes will be about, and open the forum to our partners for comments and ideas.


Industry Trends & Demands- Alaska to Maine
By: Tim Callender, Esq.

It’s about this time each year that travel really starts to kick in to high gear for numerous Phians.  From Adam, to Ron, to Mike, to Garrick, to me…. Planes, trains and automobiles!  I for one view this as an opportunity take our passion for this industry and our passion for cost-containment and unique solutions all across the nation.  This week I will be lucky enough to be a speaker at the Alaska Association of Health Underwriters Annual Expo in Anchorage, Alaska.  It will be my privilege to spend time with this great group and focus on innovating in the self-funded space.  I will be talking about cutting edge solutions that can help self-funded plan sponsors, TPAs, consultants, and other industry stakeholders keep health plan costs down while reducing the legal risks associated with self-funding.  Specifically we will be focusing on third-party fiduciary transfer opportunities to minimize legal liability; subrogation and recovery opportunities to maximize dollars returned to a plan’s pocket; and out-of-network solutions that can be utilized to keep out-of-control provider billing down while providing clear resolution on seemingly open-ended claims.  In addition, I look forward to some great discussion on plan documents and how the proper utilization of cutting-edge language is key to support all of these solutions.

Billing Itemization Required?
By: Jon Jablon, Esq.

Question: is a medical provider required to give an itemization as part of the billing? Answer: Generally no. Texas and Florida have passed legislation requiring them in certain instances, but often TPAs and plans must make the arguments that (1) the bill is not complete or “clean” without an itemization, and (2) the itemization is part of the medical record, which the patient is entitled to pursuant to HIPAA.

Beth Israel, Lahey in advanced merger talks
By Jessica Bartlett

Beth Israel Deaconess Medical Center and Lahey Health have announced plans to combine forces for the fourth time, a move that would create an entity rivaling the size of Partners HealthCare.

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What is ‘Repeal and Replace?’ A Guide to Trump’s Health Care Buzzwords
By Benjy Sarlin

President Donald Trump and GOP lawmakers have yet to come up with a plan to repeal and replace the Affordable Care Act. But in the meantime, there’s already a complicated vocabulary to describe the process and its goals.

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Innovation at Its Finest- Cash Only Payment Model
By: Chris Aguiar, Esq.

I’ve had the honor and privilege of meeting Dr. Keith Smith and have worked with several benefit plans who have utilized his Center as part of their benefit offerings.  Dr. Smith is a true innovator in the cost containment space who genuinely cares about his patients and providing quality care at reasonable prices.  Read about his journey to a cash-only payment model.  Contact The Phia Group to find out how you can innovate and contain costs within your employee benefit plan.

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A Personal Experience- Self-funded Employee Benefit Plan
By: Adam Russo, Esq.

Yesterday, I posted a personal experience I had with the very first employee benefit plan I ever designed – my own. The Phia Group’s self-funded employee benefit plan is not just the plan my employees are on, it’s the plan my wife, four kids, and I are on. I pay a lot of attention to the experiences of our covered individuals so that we can make our plan better and in turn, the thousands of plans across the country that we represent. I woke up yesterday feeling pretty horrible so I went to an urgent care facility with whom we directly contract. The experience lasted 30 minutes. I had no co-pay and the generic drugs I needed had no co-pay as well.  The total cost to the plan was $250 for the visit and the prescription.

If I walked into a hospital emergency room the cost to the plan would have been $2400 and my out of pocket would have been $250. I wonder if I would still be in the waiting room. So many people have no idea that urgent care facilities are quality places with short waiting times and low costs. Educate your employees and incentivize them to want to lower the cost of healthcare.

Concerns about Health Care Coverage Mandates
By: Brady Bizarro, Esq.

One of the biggest unknowns of the Trump Administration’s health policy priorities is whether or not the new administration plans to repeal the individual and employer mandate. The White House has already directed federal agencies to “ease the burden” of ACA regulations on employers. Ditching the employer mandate would significantly change the landscape of employer-provided insurance, and it is something we will be watching closely.

LOA = Continuation of Coverage, or does it? One of the “Gap Traps”
By: Kelly Dempsey, Esq.

It’s intuitive to think that a leave of absence (LOA) from employment is coupled with a continuation of health plan coverage (CoC), especially if the leave is illness related; but to the dismay of many, a CoC isn’t always coupled with a LOA. Many employers struggle to align their plan docs with their EE handbook which increases the potential for a gap in stop-loss coverage. While most federal and state laws do not require a CoC, employers can provide the benefit of continued coverage – but if the employer wants stop loss to help out, the terms of CoC need to be spelled out in the plan doc.

Egregious Billing Hits the Common Man – Who Now Has a Place to Vent Their Frustration
By: Garrick Hunt

For those of us who are embedded in the health care industry, we know that the greatest issue with health care in America is the price tag. For the average American, health care is all about “what’s my out-of-pocket going to be?” Just recently a friend of mine, an average America to be sure, took to social media and went on a tangent about their bill. He was completely dumbfounded as he read through each line item…I laughed a little, unfortunately, this is the state of the industry.