Phia Group

No Surprises Act & “Plan Websites”

On March 19, 2021
We received a great question about whether plans must host the provider list and directory on their website or can simply link to it. Read to learn more.

I Hate Surprises!

On December 22, 2020
The "No Surprises Act" is a proposed law that relates to "surprise" balance health insurance bills. Click to learn all about what it is and what it isn't.

Simple Negotiations Made Not-So-Simple

On July 23, 2020
Something as simple as a plain old claim negotiation can still develop certain unexpected hiccups. Learn more about how to navigate these with this informative post!

Did HHS Just Ban All Surprise Billing During The COVID-19 Pandemic?

On April 29, 2020
Health care providers cannot balance bill COVID-19 patients. But if everyone is a potential COVID-19 patient, can they balance bill anyone? Read more.

COVID-19 Testing & Cost-Containment

On April 1, 2020
The CARES Act gives power to health care providers to set the rates health plans must pay for COVID-19 testing. Learn how plans should respond.

New Insight on Provider Surprise Billing

On February 17, 2020
Many states have enacted protections against balance billing and surprise billing, however, these state laws have limited applicability. Learn more.

Washington’s “Surprise” Billing Law Goes Into Effect – January 2020

On December 9, 2019
The law patient out of the equation entirely by and leaves the provider and payer to sort out the issue of any remaining balances. Read more.

Patients are Increasingly Being Sent to Collections and Finding Themselves In Court – Sued by the Providers That Swore to Protect Them

On September 20, 2019
Court clerks in various geographic regions witnessed an undeniable uptick in the number of lawsuits being filed by hospitals and providers against patients.

Lots of Moving Parts

On September 11, 2019
As self-funders know, there are multiple considerations involved in most decisions. Even negotiating a pre-payment bill can involve many questions.

Don’t Confuse Appeals with Balance-Billing!

On August 6, 2019
https://www.phiagroup.com/Media/Posts/PostId/878/controversy-surrounds-the-most-expensive-drug-in-the-world

Network Contract Drafting: You’re Doin’ It Wrong

On July 1, 2019
Our consulting team came across a network agreement that had the nuance of indicating that the provider would bill amounts in line with market standards.

The Reference Based Pricing Stew

On January 17, 2018
Reference-based pricing tends to be something you will love or hate. It is put together like a stew by compiling a ton of different ideas which can result in good stew or a very bland one. It can become very complex due to the industry and other factors. Read more about RBP with The Phia Group

A House Divided

On August 7, 2017
Find out how to avoid health plan and stop loss disagreements for self-funded health insurance claims with this helpful article.

Magical Words in Claim Negotiation: “Please Send Claim Back for Processing”

On July 19, 2017
Jason Davis shares his 15 years experience in healthcare negotiation and offers ways to handle pushback from seemingly abusive providers.

Full Billed Charges: A Question of Geography

On June 21, 2017
Do providers reserve the right to receive full billed charges from your plan? How is your plan set up? Find out with this helpful article.