Phia Group

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.

A Love Letter to Plaintiffs’ Attorneys Everywhere

On June 7, 2022
You know, in the modern information and technological age it is rather easy to forget that we are not in Kansas, anymore, i.e. the 1990s; anything you say or do on the internet can be accessed by the masses, can and will be used against you, and it will never go away. On the same token, it is important to understand the intended audience and perspective of the speaker and even perhaps get to know the person before you judge them based on what I, personally, would consider a (negligent, at worst) throw away phrase.

The Mess in the American Healthcare System | The Phia Group

On April 25, 2022
Do you have someone to relate to when it comes with the health care system? This blog discusses some of the hardships people go though with healthcare.

Traditional Insurance to Self-Funded Plan | The Phia Group

On March 4, 2022
Wondering what to do about the increasing costs of providing health benefits? Learn about moving from a traditional insurance model to a self-funded plan.

The Tax Man is Dead; Long Live the Health Plan!

On January 21, 2022
Learn the difference between healthcare and health insurance, and why health plans, health insurance and employers are often the targets of policies.

Don’t Swear Off MHPAEA Compliance for the New Year

On December 29, 2021
Have you been keeping up with your Non-Quantitative Treatment Limitations (NQTL) analyses? Learn about the processes needed to ensure MHPAEA compliance.

The Fear Group

On December 17, 2021
Learn about the impact Covid had on Accountable Care Organizations (ACOs) and the new trend of network replacements with reference-based pricing (RBP).

What Kind of [Month] Has it Been?

On December 2, 2021
Learn about the policies and issues in the health care industry including abortion, the Omicron variant, vaccine boosters and the Build Back Better Act.

The NBA Health Care Scandal

On October 28, 2021
Learn more about health care fraud in sports leagues, the recent NBA health care scandal and what health care plans can do to prevent fraudulent behavior.