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Phia Group Media


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

On January 21, 2022
People (especially politicians) refer to “healthcare,” when in fact they are referencing health insurance. When they talk about the cost of healthcare, they don’t mean how much a provider charges for the care they provide. Instead, they are referring to the premiums, co-pays, and deductibles for which the patient will be responsible out-of-pocket.

Reasons for the Value-Based Care Gap Between Public Payers and Employer Groups

On January 10, 2022
The long-term struggle over the price of health care services between providers and payers is a tale as old as time. On one side, providers want to preserve the status quo, fee-for-service payment (FFS) system, which often leads to unnecessary treatment and wasteful health care spending. Meanwhile, payers have consistently pushed new payment models that attempt to tie spending with results. Collectively, the models pushed forward by payers are often referred to as “value-based care” (VBC) or “alternative payment models.”

Don’t Swear Off MHPAEA Compliance for the New Year

On December 29, 2021
Mental Health Parity continues to be a priority for DOL compliance – and should be on every plan’s wish list this Holiday Season to have in case the DOL or a plan participant requests for a copy of the plan’s mental health parity comparative analysis.

Roe v. Wade/Planned Parenthood v. Casey

On December 21, 2021
Over the past few weeks, in light of the Supreme Court case Dobbs v. Jackson Women’s Health Organization, hearing arguments over Mississippi seeking to ban abortions after fifteen weeks of pregnancy, the landmark 1973 Roe v. Wade case has come to the forefront of our attention. For the sake of understanding historical context, the following is a brief background to the case that laid the groundwork for the current Supreme Court precedent on abortion rights … and may get overturned by the summer.

The Fear Group

On December 17, 2021
The list of innovative and promising approaches to medical cost containment that have been beaten to a pulp by the pandemic is long, and I could keep offering examples, but I would like to instead focus on the positives. I’ve often heard that you can’t have bravery without fear, because bravery is – by definition – the act of facing one’s fears… To be brave, you must first be afraid, and then act despite it.

What Kind of [Month] Has it Been?

On December 2, 2021
As we approach the new year, let’s take a moment to pause and reflect on the whirlwind of policies, proposals, and issues swirling in the end-of-2021 zeitgeist as we brace for 2022. So, where to begin…

The NBA Health Care Scandal

On October 28, 2021
One person submitted paperwork for $48,000 worth of root canals and crowns on eight teeth at a Beverly Hills dental office--while he was living in Taiwan. Another individual filed a $19,000 claim for chiropractic services that he (allegedly) never received. And then there were suspicious invoices, filled in with (again, allegedly) fraudulent dates and account numbers, one of which was filed for services in a "wellness office" that specialized in "sexual health, anti-aging, and general well-being."

Dialysis Carve-Outs and Network Contracts: Like Oil and Water

On September 30, 2021
Many plans choose to "carve out" dialysis claims, or pay them at a different rate than other claims but it can become a problem depending. Find out how.

A Failure to Communicate

On August 13, 2021
What is insurance? Why are there problems with health insurance in the U.S.? Read about the healthcare system and insurance through the lense of COVID-19.

Canadian Drug Importation – Back on Track (but not for everyone)

On July 19, 2021
The Biden administration is likely to uphold a Trump administration executive order to approve certain legal foreign drug importation programs. Learn more.

MHPAEA Compliance: The Dreaded NQTL Analysis

On June 1, 2021
The MHPAEA now requires NQTL analyses: need help understanding the policy or analysis guidelines? Contact The Phia Group today.

HHS Resolves the Conflict – Sex Discrimination Includes Sexual Orientation and Gender Identity

On May 11, 2021
HHS resolved Section 1557's nondiscrimination policies. The interpretation rules that sex discrimination applies to sexual & gender identity. Read more.

DON’T PANIC – Mental Health Parity Compliance Expanded

On February 8, 2021
Ease your mind about complying with Section 203 of the Consolidated Appropriations Act. Learn more about this Compliance and its requirements/process.

HIPAA Compliance Audits – Good News and Bad News

On February 1, 2021
The government recently released findings of the extensive HIPAA compliance audit performed in 2016 and 2017. Click to learn more about the results!

Addition By Division

On January 11, 2021
Learn all about what a "spinoff" is when it comes to health benefit plans. Click to find out about how they come to be and how your employer plays a part.