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The Indirect (But Significant) Impact of a Recent Massive Healthcare Breach on Benefit Plans

On March 11, 2024
It’s not often we see a healthcare/health benefit story so big that it crosses into the mainstream. The recent cyberattack in the healthcare industry is just that type of story, however, and the American Hospital Association has already called it “the most significant cyberattack on the U.S. health care system in American history.”

Is the Department of Labor Offsetting a Major Problem?

On January 3, 2024
As if Americans on employer-based health plans didn’t face enough obstacles in trying to obtain reasonably priced healthcare.

Empowering the 2023 SIIA National Conference

On October 26, 2023
Earlier this month, the self-insurance industry’s most prominent thought-leaders, innovative service providers, and esteemed subject matter experts convened at the 2023 Self-Insurance Institute of America (SIIA) National Conference at the JW Marriott Phoenix Desert Ridge Resort & Spa. The SIIA National Conference, which this year covered such pressing topics as artificial intelligence, surprise billing, emerging trends impacting the employer stop-loss market, and recent legislative and regulatory updates, is widely considered to be the self-insurance industry’s annual marquee event, bringing together hundreds of industry professionals including TPAs, vendors (there were over 950 booths representing industry vendors stationed in the exhibitor hall), brokers, captive managers, stop-loss carriers, and solution providers.

The Power Dynamics of Gag Clauses

On August 14, 2023
In the already-intricate world of health benefits, Congress passed the Consolidated Appropriations Act, 2021, which is notable to the self-funded industry for three main reasons: it expanded the Mental Health Parity and Addiction Equity Act to require health plans to proactively document their compliance via the nonquantitative treatment limitation (NQTL) analysis; it introduced the No Surprises Act, which fundamentally changed how claims disputes are handled; and it prohibited health plans from entering into contracts containing gag clauses. This particular blog post focuses on gag clauses. The implications of this prohibition on transparency and patient rights are immense, and it’s worth looking into the power dynamics at play since it’s not quite as simple as saying that plans can no longer have these gag clauses.

Diapers & Wipes Reflection

On August 3, 2023
As my family and I look forward to celebrating our daughter Kinsley’s first birthday this Sunday, we have revisited some of our fond memories and challenges in our first year as a family of five. In doing so, we have discussed how helpful Phia’s “Diapers and Wipes” program has been to our family.

Benefest 2023: Talking Costs and Laws with Carriers

On July 31, 2023
By March, amidst the snowbanks contracting and days growing incrementally longer, conference season – at least for the healthcare industry -- is in full bloom. One of the marquee Massachusetts-based healthcare conferences, Benefest 2023, focused on “shaping the future of healthcare” in the commonwealth, was held earlier this summer at Worcester’s Polar Park -- during the peak of conference season.

The Phia Group and Healthcare Recovery Solutions (HRS) Join Forces to Empower Healthcare Payers in Recovering Lost Dollars from PFAS, PFOA and PFOS Payouts

On June 29, 2023
The Phia Group, a distinguished leader in healthcare cost containment, and Healthcare Recovery Solutions (HRS), a prominent healthcare mass tort subrogation expert, announce their most recent and pressing initiative. In response to an environmental crisis in the US, our team is launching a robust initiative to provide unparalleled recovery solutions for healthcare payer clients. Through the integration of our unique and exclusive capabilities, including patented, state-of-the-art mass tort data analytics and subrogation recovery specialists, we will offer an extraordinary opportunity for clients to identify and recover medical costs associated with toxic chemicals known as PFAS, PFOA and PFOS.

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?

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 Dobbs Case – What Group Health Plans and Employers Need to Know | The Phia Group

On July 1, 2022
On June 24th, the U.S. Supreme Court handed down one of its most controversial and impactful decisions in half a century by overturning Roe v. Wade. This decision has sweeping implications for group health plans. In this special edition of the Empowering Plans podcast, The Phia Group’s Chief Legal Officer, Ron Peck, is joined by attorneys Jen McCormick and Brady Bizarro to unpack the Court’s opinion, what’s likely to happen next, and most importantly, how health plans should respond to this historic ruling.

Empowering Plans: P116 – Right to Repair and Healthcare

On August 20, 2021
This podcast discusses Biden’s executive order on right to repair. Learn how it impacts healthcare costs, patient safety and intellectual property rights.

Empowering Plans: P95 - 2020 Election Results (So Far) – Our Takeaways

On November 9, 2020
In this episode of Empowering Plans, Ron and Brady are joined by Attorney Nick Bonds to discuss the 2020 election results. For now, it looks like we will have a new president in 2021. What will that mean for the healthcare industry? If the Senate stays in Republican control, is a public option likely? Will Obamacare be replaced? What will happen to popular issues such as prescription drug reform and surprise billing bans? We are covering all of the angles and breaking down all of the possibilities.

Benefits on the Ballot – A Political Update for Health Benefits Professionals

On September 22, 2020
Election season is underway. The future of healthcare will be decided via the ballot box, court rooms, and congressional halls. Pandemic or no pandemic, the gears of democracy are turning and what happens now will have long term effects for us all. Join The Phia Group as they discuss the most important elections (including candidates’ positions on health), ongoing legal cases, and proposed laws. They will dissect each and provide you with not only thoughts on how they may impact us, but how we can best prepare for likely outcomes.

The Top 10 of 2020: Cost Containment Measures to Implement Right Now

On March 10, 2020
Self-funding can be great if you know how to use it – but it can also be disastrous if done wrong. Health plans trust their TPAs and brokers to make the right decisions for them, and cost-containment is always the right decision. From choosing a stop-loss carrier all the way to handling appeals, the self-funding market is full of options and customizations, and some are (much) better than others. Join The Phia Group’s legal team as they discuss the cost-containment measures they encounter most frequently, and tell some success stories, some horror stories, and how you can make the best decisions for your clients’ bank accounts.

Empowering Plans: P72 – The Young & The Restless

On November 21, 2019
Adam Russo and Brady Bizarro sit down with Craig Clemente, Chief Operations Officer at Specialty Care Management and outgoing Chairman of the SIIA Future Leaders Committee, to discuss the future of the committee and the many ways they intend on engaging the younger generation. Make sure you tune in to find out what SIIA has in store for 2020 and beyond.