Phia Group

The Skinny on Weight Loss Drugs

On February 21, 2024
From Contrave to Saxenda to Wegovy and beyond, society is being bombarded with messaging about weight loss drugs. While many publicly debate their efficacy and long term viability, far fewer are openly asking who will pay for them – and how. For those of us that sponsor and service health benefit plans, the costs arising from this trend are very real. While we want to help people lose weight, get fit, and improve their overall health – the best way to approach this matter is still uncertain. Join The Phia Group for another free webinar! Our team will discuss this very relevant topic, including related issues such as off-label drug usage, international drug importation, defining medical necessity, plan drafting and exclusions. Likewise, the importance of educating plan membership about the costs of healthcare, and what it means to be self-funded.

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: P74 – Medicare Podcast for All!

On December 19, 2019
This is it! This is it! Ron and Brady pick apart Elizabeth Warren’s Medicare-for-All proposal, and the concept as a whole; the good, the bad, and the really bad. You can’t afford to ignore this one.

To Pay, or Not to Pay … The Guide to Handling Claims, Denials, and Appeals

On May 23, 2019
Join The Phia Group’s legal team as they discuss the good, bad, and ugly truths about the claims process, and how to safely navigate the various TPA and health plan duties associated with it.

Keeping PACE with Appeals, Trends and Fiduciary Responsibility

On May 22, 2017
As TPAs, consultants, and Plan Sponsors utilizing The Phia Group's Plan Appointed Claim Evaluator service, you are entitled to exclusive educational material.

Decisions, Decisions: Which Plan Types Work Best for Which Groups, and Why?

On May 16, 2017
Between a traditional PPO plan, a MEC or “skinny” plan, reference-based pricing, narrow network, cafeteria plan, or high-deductible health plan, who can choose? They all have their nuances, and which plan type is best for a given plan sponsor will depend on factors including risk tolerance, geographical location, employee base, and more.

Medical Bill Blues: Pre-Payment Contracting and Negotiation, Pricing Alternatives, and Post-Payment Recovery of Overpayments

On March 23, 2017
It’s common knowledge that not every network contract adds real value, nor can medical providers always be relied upon to bill responsibly. As the fiduciary duty to be prudent with plan assets becomes increasingly relevant, it's important that self-funded health plans, and those who service them, not fall behind.

Top Miscues Employers Make When It Comes To Their Health Plans ... And What We All Can Do To Become Health Plan Heroes

On February 15, 2017
Employers who self-fund their health plan act as a traditional employer, a plan sponsor, and a plan administrator. Juggling this many roles, conflicts and contradictions are bound to happen. For instance, an employee handbook’s handling of disability leave may conflict with the health plan document as it relates to employment and plan coverage.

Back to The Self-Funding Future – Which Echoes of 2016 Will Continue to Impact Self-Funding in 2017

On January 19, 2017
The past decade has ushered in both outrage and opportunity for self-funded plans, and 2016 was no different. The characteristics of self-funded plans continued to alter in concert with new laws and regulations. While these bureaucratic efforts often hindered our ability to self-fund, for those daring enough to change with the times, we saw increased growth and prosperity. We will no doubt see these issues and opportunities continue to evolve in 2017, and only those that prepare will thrive.

Independent Consultation & Evaluation: ICE, ICE, Baby!

On September 22, 2016
Our industry is plagued by issues related to compliance, contracts, and cost-containment – and a myriad of other legal issues as well. Engaging an expert for a second set of eyes is a chore in itself, requiring approval from management or an individual group as well as a cost-benefit analysis of the expert’s fees – sometimes resulting in the decision not to consult a neutral third-party at all.

Back to Basics: Plan Documents 101 (Part 2)

On July 13, 2016
When we think of hot topics in the self-funded industry, plan document drafting is hardly the first thing that come to mind. Instead, issues such as fiduciary duties, reference-based pricing, transgender coverage, employee incentives, and provider abuse are on the tip of everybody's tongues. All these topics, however, share a common feature: they're all reflected, in some way or another, within the plan document. Without compliant and effective plan document language, a plan can't offer robust benefit programs while containing costs.

The Tangled Web of Contracts

On May 12, 2016
The self-funded industry is made up of a complex system of contracts, and navigation across them is anything but simple. Network contracts supersede plan documents; Administrative Services Agreements “add” plan provisions, stop-loss policies embrace carve-outs but networks prohibit them, employee handbooks promise benefits not provided by the SPD…and those are just a few examples of areas of confusion. Thank you for joining The Phia Group on May 12th, 2016 as its legal team gave a crash course in contracts. Cost-containment can be impacted by the contracts you sign, and there are often exceptions and restrictions buried deep down, or potential issues not considered beforehand. In this webinar, The Phia Group explained some of the contracting pitfalls experienced on a daily basis within the self-funded industry.

The Phia Group, LLC Comments on Recent Industry Developments

On October 23, 2015
These last few weeks have brought with them a whirlwind of controversy and concern. The Phia Group, LLC is pleased to announce that it will be addressing three of the hottest topics during its monthly webinar. If you have not yet signed up for our FREE webinar, to be held on Thursday, October 30th, 2014, from 1:00 – 2:00 PM EST, then you will most certainly be missing out!