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Empowering Plans: P141 - Do You Mind (…The Gap)?!

On August 5, 2022
In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jen McCormick and Jon Jablon discuss the age-old topic of stop-loss gaps, with a modern twist. Emerging law and industry trends color so many decisions that self-funded plans and those that service them must make on a daily basis, and one player that sometimes gets forgotten about is stop-loss. Since stop-loss coverage expectations don’t always align with reality, health plans, TPAs, and brokers need to be proactive, to find potential gaps and try to rectify them before they evolve into real problems.

Lessons From Marietta’s Victory

On August 2, 2022
In one of last month’s momentous Supreme Court cases, Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., the justices confronted the legal question of whether the health plan covering employees of a small Ohio hospital contained a dialysis carve-out discriminating against participants with end-stage renal dialysis (ESRD). The Court, in a 7-2 decision, ruled that there was no such discrimination because the dialysis carve-out neutrally applied to all outpatient dialysis claims, not just those involving ESRD, and thus did not violate the Medicare Secondary Payer Act (MSP). While the Court’s ruling in favor of Marietta Memorial Hospital was surely a major victory for health plans implementing dialysis carve-outs, as well as plan sponsors, the contextual background to this case speaks to some critical underlying issues in the healthcare industry.

HHS Proposes Rules for 1557 Covered Entities

On August 1, 2022
On July 25, 2022, HHS announced a proposed rule that would strengthen the protections granted by Section 1557 of the ACA in various contexts. In line with the administration’s previous interpretations of the Supreme Court’s holding in Bostock v. Clayton County, HHS reinforces that 1557’s protections against discrimination based on “sex” extend to sexual orientation and gender identity.

Louisville Business First Names The Phia Group, LLC a 2022 Best Place to Work in Greater Louisville

On July 29, 2022
Read how The Phia Group was named the best place to work in greater Louisville. Learn more about The Phia Group and how they empower health plans.

The Phia Group's 3rd Quarter 2022 Newsletter

On July 28, 2022
The Phia Group is off to a great start in the third quarter of 2022! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

The Stacks – 3rd Quarter 2022 Newsletter | The Phia Group

On July 22, 2022
This is "The Stacks" from The Phia Group's 3rd Quarter 2022 Newsletter

Should Plans Better Address Mental Health Benefits? | The Phia Group

On July 22, 2022
In the wake of the COVID-19 pandemic, the government has announced that we are facing another crisis – one on mental health. Participants are clamoring for more access to mental health care than ever before. The COVID-19 pandemic only highlighted the lack of availability of mental health care in the US, including care that is covered by plans. Ron Peck, Chief Legal Officer, and attorney Kaitlyn MacLeod are here to talk about what plans are doing to address the mental health crisis and how mental health parity comes into play for plans, patients, and providers.

The Forum Redux

On July 21, 2022
After a three-year hiatus, The Phia Forum resumed on July 11th, exclusively geared toward Independent Consultation and Evaluation (“ICE”) clients, many of whom have been using Phia’s health care cost containment services for over two decades. During the two days of events, the first of which occurred at The Phia Group’s new office in Canton, Massachusetts, “ICE” clients enjoyed seminars highlighting enhancements to current services while learning how new developments in healthcare—and American legal landscape— will impact their businesses.

Supreme Decisions – A Proactive Approach for Health Plans to Dobbs and Marietta

On July 19, 2022
The U.S. Supreme Court may be in recess until October, but its landmark healthcare rulings over the past month continue to reverberate across the country and across our industry. These decisions will have strong implications for plan sponsors in particular and The Phia Group is here to explain how your health plan, and its administrators, may be affected by these momentous developments. Please join us as we delve into such current affairs (not to mention history in the making) from a unique healthcare cost containment perspective.

One Lesson We Must All Learn from Dobbs v. Jackson Women's Health Organization

On July 14, 2022
Many – from neighbors to the media – are buzzing about the Dobbs v. Jackson Women's Health Organization decision, handed down by the Supreme Court. Of course, many (most?) of those people discussing this case might not even know the name of the case; referring to it instead as the “Roe v. Wade” case, or the case that overturned Roe.

Stop Loss and Subrogation | The Phia Group

On July 8, 2022
In this episode of the Empowering Plans podcast, attorneys Chris Aguiar and Cindy Merrell, discuss potential obligations of health plans to their stop loss carriers in the event of a recovery through subrogation.

Book of Russo: Chapter 2

On July 6, 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. Marty Makary, have to say about price transparency, price gouging, and who is typically responsible for the high cost of care.

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.

U.S. Supreme Court Rules on Dialysis Carve-outs | The Phia Group

On June 24, 2022
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Andrew Silverio, break down the Supreme Court’s ruling in the Marietta case on dialysis carveouts. What does the ruling mean for self-funded plans that wish to carve out dialysis claims? Our experts dig deep into the legal analysis and explain how plans can stay within the parameters of this decision. Finally, they address important points raised by the dissent and consider the broader impact on the industry.

The Book of Russo: Chapter 1

On June 17, 2022
In the first episode of The Book of Russo, tune in to find out what The Phia Group’s CEO, Adam Russo, has to say about the new podcast series, healthcare transparency, and so much more.