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Phia Group Media


More Twists to the IDR Process in the No Surprises Act?

On August 25, 2022
The latest final rule on the No Surprises Act has finally been released by the U.S. Departments of Health and Human Services, Labor, and Treasury. There are some important clarifications made in this latest rule, including confirmation that the Qualifying Payment Amount (QPA) is no longer the presumptive out-of-network rate.

Marietta Memorial Hospital Employee Health Benefit Plan v DaVita Inc. - Dialysis Carve-Out

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.

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.

Transparency in Coverage Compliance? | The Phia Group

On June 16, 2022
It’s Almost July 1st – Are You Ready for Transparency in Coverage Compliance?

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 Baby Formula Shortage and Preventive Care

On May 31, 2022
The baby formula shortage in the United States has been worsening for months. Our country’s supply was already squeezed by a perfect storm of pandemic-related supply chain issues and inflation costs. Then, with the detection of dangerous bacteria leading to the sickening and death of several infants, Abbott Nutrition shut down its Michigan plant in February – a plant that formerly supplied nearly one-fifth of all the baby formula in the country.

Limits of Arbitration Provisions on Participant ERISA Claims

On May 9, 2022
A recent sixth circuit decision shows limits of arbitration provisions on participant ERISA claims. Read our blog to find out the latest actions taken.

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.

California Law Still Governs Most Surprise Bills

On April 14, 2022
Learn about the letter California recently issued detailing the relationship between the No Surprises Act and their existing balance billing protections.

Texas’ New Pre-Authorization Exemption Law

On April 4, 2022
Learn about the new pre-authorization exemption law in Texas and whether this would prohibit health plans from incentivizing pre-authorization.

Telehealth Coverage & HSA relief for HDHPs | The Phia Group

On March 22, 2022
Learn about the CARES Act, the Consolidated Appropriations Act, and how they temporarily extended HSA relief for HDHPs and telehealth coverage.

Mental Health Compliance Issues | The Phia Group

On March 15, 2022
Learn about how health plans are struggling to maintain MHPAEA compliance, insufficient NQTL comparative analyses, and how you can avoid these issues.

Monetary Relief for Diabetic Americans | The Phia Group

On March 14, 2022
Learn about the legislation introduced to ease the financial burden on millions of diabetic Americans by capping insulin prices at 35 dollars per month.

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.

MHPAEA Self-Funded Plans and NQTL Analysis | The Phia Group

On February 22, 2022
Read about the burdens imposed on self-funded plans by the MHPAEA. Learn about challenges from Non-quantitative Treatment Limitation (NQTL) analyses.