Recent Posts

• Stories from the Front Lines – A Collection of Recent Relevant Case Studies & COVID-19 Vaccine Mandate
  
  September 21, 2021
  It has been said that failure is often the greatest teacher. This is true both for the one that failed, as well as those who learn from others’ experiences. Join The Phia Group as they share cautionary tales meant to enlighten, and ensure you don’t make the same mistakes or fall into the same traps. From mishandled appeals to fiduciary breach; misapplication of plan terms to compliance violations; dubious provider billing schemes to abusive treatment facilities; by witnessing others’ unfortunate experiences (and hearing how The Phia Group responded), you will be better prepared when similar issues affect you. Don’t worry; the names have been changed to protect the innocent! We’ll see you there.
• The Provider Perspective – Analysis and Response to How Providers are Reacting to Recent Rule Changes and Reform
  
  August 24, 2021
  For months we have been dissecting new and forthcoming rule changes, to address their impact on the health benefits industry. Yet, everything from laws regarding transparency to surprise balance bills will also substantially impact the provider community as well, right? Maybe… Maybe not? Join The Phia Group for another complimentary webinar, as they assess how providers are – presently, and in the future – likely to react (or not react) to the new healthcare pricing rules, as well as address best practices to fight back against abusive provider billing tactics.
• Surprise, surprise! Analyzing the No Surprises Act Part Deux
  
  July 12, 2021
  In this webinar, The Phia Group attorneys discuss the No Surprises Act: dive into the world of surprise bills and dissect this important law. Watch now!
• Back on Track: Plan Sponsor Priorities for the Second Half of 2021
  
  June 21, 2021
  In this webinar, The Phia Group's attorneys explain how plan sponsors and partners can get back to normal after COVID-19. Watch the webinar here.
• The Light at the End of the COVID Tunnel – Pandemic Fallout and Permanent Changes
  
  May 24, 2021
  In this webinar, the Phia Group attorneys discuss COVID-19 pandemic regulations and how they could influence the future. Watch the webinar here.
• Face the Change – Plan Design, Administrative Claims Processing and Payment Changes Needed in Light of COVID-19 and New Regulatory Obligations
  
  April 27, 2021
  Health benefit plans and the entities that serve them are feeling the squeeze. Federal and State lawmakers are issuing new regulations on an almost monthly basis, including but not limited to the American Recovery Plan Act (ARPA), COBRA, Mental Health Parity, and the No Surprises Act. Meanwhile, health care providers are making adjustments in response to the economic damage they suffered during the COVID-19 pandemic. Join The Phia Group as they share with you the information you need to remain compliant, while also predicting what the provider industry will look like in the months and years to come. In addition, The Phia Group will immediately host two breakout sessions following the webinar, with one session addressing ARPA, COBRA, regulatory updates and requisite plan updates in greater detail, and the other session will ensure attendees know what to do to maintain compliance with Mental Health Parity in the face of ever-changing provider practices.
• Fallout in the Spring – COVID Claim Disputes, Surprise Billing RBP Opportunities & Return to Work Vaccine Mandates
  
  March 24, 2021
  The costs and conflicts ushered in by the COVID-19 fallout are becoming more apparent. Industry members are debating numerous issues, such as when a plan should pay and whether workers’ compensation should be a primary payer. Both opportunities and challenges appear, especially for fiduciaries, from post-pandemic legislation, such as the No Surprises Act, to state and federal COVID-19 rules – impacting Reference Based Pricing and claims processing in general. Join The Phia Group as we discuss post-COVID era regulations applicable to benefit plans, as well as industry issues emerging from this new chapter in the pandemic saga.
• A Blueprint for Success – Lessons from 2020, Expectations for 2021
  
  February 25, 2021
  Join The Phia Group to learn from the past, and plan for the future! In this webinar, The Phia Group will both examine what has happened as well as predict what is to come, as they help you identify what needs to be done to ensure the best possible outcomes for this coming year. They will discuss President Biden’s first month in office, identify whom he has appointed for key roles (and examine their track records on healthcare), as well as dissect the issues that were most relevant in 2020 – ensuring we learn from both the victories and losses of the year that has ended.
• The “No Surprises Act,” COVID Relief, and Plan Design Changes Impacting Your Business in 2021
  
  January 20, 2021
  After a hectic political showdown, the president has signed legislation which includes comprehensive protection from surprise medical billing. This 5,000-page bill, along with a raging pandemic and a new administration, is certain to have our industry scrambling to keep up. Join The Phia Group in a new webinar format as they discuss the COVID-19 relief bill, the impact on the industry, and everything in between. From plan design changes to updates on fiduciary duties and subrogation, we have got you covered as we ring in the New Year. Following the one-hour webinar, there will be two 30-minute breakout sessions, addressing plan design changes, stop-loss issues, and legal and regulatory updates affecting claims.
• A Transparent 2021 - Further Analysis of the Year to Come
  
  December 15, 2020
  Following on the heels of their incredibly informative assessment of what to expect in 2021, The Phia Group will dives back into their pool of predictions in another free webinar. The team targets rules that will impact 2021, including the recently released transparent pricing rules. Additionally, they discuss some best practices developed and applied in 2020 and how those changes will assist plans in 2021. If success in 2021 is in your plans, check out this webinar and look forward to tomorrow.
• Desperately Looking Forward to 2021
  
  November 16, 2020
  The end (of 2020) is near, and we are anxiously looking forward to 2021. Between the Presidential Election, the COVID-19 Pandemic, and the ACA’s “Day in Court” before SCOTUS, any one of these ongoing topics would be enough to keep us busily planning for what is to come. Suggesting that 2021 is poised to be one of the busiest years in our industry’s history might be an understatement. At times, it may be overwhelming to keep up with everything that is impacting us – as employers, as service providers, and as human beings. That’s why The Phia Group is proud to invite you to enjoy another webinar, where we will be discussing these and other hot topics, forecasting what we expect to see in 2021, and giving you a head start as you – like we – plan, and look forward, to 2021.
• New Opportunities to Save, Create Revenue & Avoid Scary Practices
  
  October 19, 2020
  Join The Phia Team as they share some of the industry’s scariest blunders and gruesome practices. Turn down the lights and prepare to be horrified; but fear not... with this trick there are also treats. Not only will attendees learn from others' mistakes, but we will also pull from our bag of goodies new sources of revenue and savings for plans and administrators alike. If you miss this one, it will haunt you for the rest of your life.
• Benefits on the Ballot – A Political Update for Health Benefits Professionals
  
  September 22, 2020
  Election season is underway. The future of healthcare will be decided via the ballot box, court rooms, and congressional halls. Pandemic or no pandemic, the gears of democracy are turning and what happens now will have long term effects for us all. Join The Phia Group as they discuss the most important elections (including candidates’ positions on health), ongoing legal cases, and proposed laws. They will dissect each and provide you with not only thoughts on how they may impact us, but how we can best prepare for likely outcomes.
• Conflicts Abound – Providers & Facilities Fight Back
  
  August 17, 2020
  U.S. hospitals have lost over $200 billion from March to June as a result of canceled services due to the COVID-19 pandemic. In response, providers have changed their tactics. They are raising prices, appealing more denied claims, more aggressively fighting referenced-based pricing, and stepping up collections efforts. Now, more than ever, it is imperative for plans and their partners to be vigilant and protect their members and plan assets. Join The Phia Group’s team as they discuss these new aggressive tactics as well as the conflicts they are causing with networks and stop-loss.
• The Underlying Regulatory Landscape - Don’t Get Lost in the New Normal
  
  July 15, 2020
  As we remain hyper-focused on COVID-19, it is easy to forget other ongoing impactful industry events. Life goes on, and so too does lawmaking and litigation. Statutes, regulations, and case law have been and continue to be considered, debated, and finalized; resulting in serious, lasting effects. It behooves us all to track them accordingly. Luckily for you, The Phia Group’s legal team has done just that – and they will happily inform and advise on what to watch, and how to adjust. Join us for this free, but invaluable event.
• Old Issues, New Environment – Not The Same Old Song
  
  June 16, 2020
  Join our team of experts as we discuss familiar issues such as balance billing, surprise billing, mental health parity, telemedicine and more. Learn more.
• A Pandemic Economy – Industry Risks and Opportunities
  
  May 19, 2020
  As the economy suffers, our industry is impacted when employers furlough employees or implement layoffs, as well when employers can no longer afford to offer benefits or continue operations. Fewer benefit plans, fewer plan participants, and dramatic changes in claim type and volume are certain, leaving health benefits at risk during a time when they are most needed. Yet, there are those that are improving coverage, leveraging opportunities, and preparing to take advantage of the employer, employee, and claims growth likely to follow a lifting of stay-at-home orders. Join The Phia Group as they discuss ways administrators are extending benefits and taking care of those in need. From COBRA to workers' compensation, mandates to stop-loss, join us to discover innovative ways to conquer the challenges and come out on top.
• Reasons for Optimism
  
  April 23, 2020
  Together we are all enduring common trials. It is certainly one of the most difficult periods in our history – as an industry and as Americans; and yet, opportunities exist. Both presently, and heading down the pike, there are reasons for optimism. Join The Phia Group as they discuss the many GOOD and POSITIVE things that have both improved our industry since the end of 2019, and that are on the way. We will discuss opportunities that exist now, that are forthcoming, and why we foresee YOU flourishing post-COVID-19.
• COVID-19: The CARES Act & Workplace Safety FAQs
  
  March 31, 2020
  In the fight against COVID-19, events are unfolding at a breakneck pace. Congress just passed the largest recovery bill in American history. Employers are facing serious questions about their obligations and liability during this crisis. Join The Phia Group for this special edition webinar as we discuss the impact of this historic federal legislation on our industry and answer your questions about workplace safety.
• Special Edition - The Phia Group and COVID-19 FAQs Answered
  
  March 23, 2020
  From inquiries about how to comply with regulations to revising plan documents, The Phia Group has received many questions from brokers, employers, TPAs, and stop-loss carriers about COVID-19.
• The Top 10 of 2020: Cost Containment Measures to Implement Right Now
  
  March 10, 2020
  Self-funding can be great if you know how to use it – but it can also be disastrous if done wrong. Health plans trust their TPAs and brokers to make the right decisions for them, and cost-containment is always the right decision. From choosing a stop-loss carrier all the way to handling appeals, the self-funding market is full of options and customizations, and some are (much) better than others. Join The Phia Group’s legal team as they discuss the cost-containment measures they encounter most frequently, and tell some success stories, some horror stories, and how you can make the best decisions for your clients’ bank accounts.
• Double Dose: Revisiting Rx Drugs and Answering Your Questions
  
  February 12, 2020
  Last month, we discussed some disturbing trends surrounding prescription drugs, and what they mean for self-funding. The overwhelming feedback we received after last month’s webinar was that you, our viewers, want more information on this particular topic – so we’re back with a sequel! Join The Phia Group’s legal team as they take a deeper dive on the topic of Rx drugs, tackle the difficult questions asked in last month’s webinar, and help plans protect themselves while staying ahead of the curve.
• A Dose of Savings – Addressing Drugs, PBMs, and the Controversies Surrounding Them
  
  January 21, 2020
  Whether you are a fan of politics, profits, or identifying savings, you are likely keeping a close eye on pharmaceuticals. From life-preserving medications that have been around for decades (and whose price increases continue to outpace the national GDP) to specialty drugs that are inches away from FDA approval (and bankrupting most benefit plans), the cost tied to drugs is a hot topic. While congressional efforts to curb rising costs have stalled, pharmaceutical companies, pharmacy benefit managers (PBMs), and politicians continue to look for someone else to blame. Join The Phia Group as they discuss the Rx trends to watch for, the biggest threats to health plans, cost-containment strategies to implement, political efforts underway, and an injection of information you can’t do without.
• A Perfect Vision for 2020
  
  December 17, 2019
  Looking back at the year that was, 2019 gives us perspective and allows us to view 2020 with both optimism and concern. Open your eyes (and ears) and join the team as they review the issues, topics, and innovations of 2019 that they believe will impact 2020, as well as the strategies you need to implement now to conquer the coming year.
• Plan Language, Rx, and Lawsuits to Watch (and File): Innovation for a Changing Industry
  
  November 13, 2019
  In the face of evolving pricing models, ever-increasing drug costs, difficulties in administering claims, and increased regulatory burdens, the players in the self-funding industry need change. Not just any change, though; creative change that promotes cost-containment and makes life easier for those who support health benefit plans in one way or another.
• 2020 Forecast - Storm Clouds, Clear Skies, and the Issues that will Dominate Next Year
  
  October 23, 2019
  2020 is almost here, and The Phia Group continues its webinar series dedicated to preparing you for renewals, and the coming year. Join the team for this free webinar as they discuss the issues that impacted 2019, and are poised to dominate 2020, including (but not limited to) Mental Health Parity, Paid Leave, Health Insurance Taxes, Drug Prices, Regulations, and Coupons.
• 2020 Renewal Season - Decisions Today, Uncertain Tomorrow
  
  September 17, 2019
  It’s plan renewal season, and we find ourselves making decisions that will define how plans will operate over the next year. This is no easy task! First, we confront known issues and hurdles – such as increasing drug costs, regulatory crackdowns, and aggressive providers – looming before us. Additionally, despite the need to make these decisions now, the future is more uncertain than ever before. Between litigation challenging the constitutionality of the ACA and an already wild 2020 Presidential election, no one truly knows what next year will look like. How can we make decisions today at renewal, that address the issues of tomorrow – both known and unknown? Join The Phia Group for a “can’t miss” review of important issues impacting plan renewals, address known roadblocks, and perform an assessment of the candidates’ positions on healthcare – with an eye toward what we should be doing today to prepare for an uncertain tomorrow.
• Back to School: 2020 Renewals
  
  August 21, 2019
  As players in the self-funded industry have found out the hard way, keeping business often isn’t easy. Fiduciary obligations and other difficult situations can arise when we all least expect them, and when we are worst-equipped to deal with them (such as in the height of renewal season). By popular demand, this month’s webinar will focus on when fiduciary duties can arise, who needs to be careful, and how those duties might affect your 2020 renewals.
• Trump’s Executive Order on Transparency: How it Will Effect Each Segment of Our Industry
  
  July 23, 2019
  On June 24, 2019, President Trump issued his “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.” This Order requires hospitals to publicly post their prices, and is designed to give healthcare consumers more choice and better decision-making capabilities.
• The Impact of State, Federal Laws, and Current Market Trends on Self-Funding
  
  June 20, 2019
  Attention, self-funders: things are happening! State and federal governments have been busy beavers, either passing legislation or at least looking into it. Whether it's surprise billing laws, Medicare-for-all initiatives, or public exchange options, you need to know about it.
• To Pay, or Not to Pay … The Guide to Handling Claims, Denials, and Appeals
  
  May 23, 2019
  Join The Phia Group’s legal team as they discuss the good, bad, and ugly truths about the claims process, and how to safely navigate the various TPA and health plan duties associated with it.
• Evolving Healthcare Issues and Events You Need to Know
  
  April 22, 2019
  The healthcare space is rapidly evolving – and self-funding is no exception. Legislators, regulators, and courts are constantly providing new guidance – some good, some not. For this month’s webinar, we’re going to present some current events; we’ll discuss how they can help or hurt self-funded players, and what you can do to take advantage of them (or avoid the pitfalls created).
• Transparency: A Building Block of Self-funding
  
  March 14, 2019
  Whether from unpredictable provider charges, “black box” claims repricing, mysterious PBM rebates, or unobtainable claims data, entities operating in the self-funded space such as employers, TPAs, brokers, and stop-loss carriers have been forced to deal with a systemic lack of transparency.
• What We Love About Self-Funding in 2019
  
  February 14, 2019
  Valentine’s Day is upon us, and we’re feeling the love. Too often we, as an industry, spend our time discussing issues, problems, and concerns, and don’t dedicate enough time to the features and opportunities that make self-funding great. We focus so much on “how we save” self-funding, that we forget to celebrate the reasons why self-funding is worth saving in the first place. Join the team as they discuss what makes self-funding such a great option for so many employers and employees, as well as the incredibly cool new innovations rolling out in 2019, that will be sure to make self-funding a sweetheart for even more employers this year and beyond.
• The Affordable Care Act in 2019: A Look Ahead
  
  January 16, 2019
  This year, we mark the ninth anniversary of the healthcare law that transformed our industry. The Affordable Care Act has been under assault from the White House, from Congress, and now, it has been declared unconstitutional by a federal court. Despite the embattled state of the ACA, the Trump administration has set an agenda for the ACA's implementation this year, and it remains the law of the land. In this webinar, The Phia Group's legal team will explore the many legal and political battles that threaten the ACA's existence while covering those key provisions that have changed, those that have remained the same, and everything in between.
• What to Expect in 2019 – Part 2
  
  December 12, 2018
  To build on last month’s webinar (Part 1), join The Phia Group’s legal team for an hour on December 12, 2018, as they present the second part of this two-part series on What to Expect in 2019. Touching on topics such as appeals, stop-loss trends, reference-based pricing, and much more, this webinar will highlight current industry happenings and our predictions to help you look forward to the coming year. Just like last month: miss this one, and you’ll be left behind.
• What to Expect in 2019 - Part 1
  
  November 13, 2018
  The future is here! As we’re about to enter 2019, the undercurrents of the self-funded industry are as exciting as they are dynamic, and changes are happening at an unbelievable pace. Join The Phia Group’s legal team as they present Part 1 of this two-part series on What to Expect in 2019, which will highlight current industry happenings and our predictions to help you look forward to the coming year. Miss this one, and you’ll be left behind.
• Specialty Drugs: Trends and Issues Affecting Self-Funded Plans
  
  October 18, 2018
  No matter what corner of the industry you’re in, you know that health plans have had a constant need to contain costs as a result of skyrocketing medical bills. The rising cost of Rx drugs has certainly been an issue as well – and specialty drugs are a hot-button issue as health plans struggle to find ways to manage them.
• Back to School: Renewal Time
  
  September 18, 2018
  In the self-funded industry, being diligent with respect to employer groups, vendors, and contracts is always important – but sometimes knowing what to put on a checklist in the first place is more difficult than checking off the items. Renewal time means it’s time to impress prospective clients, keep existing clients happy, and make sure the vendors and contracts being utilized are the best possible fit for your groups. Join The Phia Group’s legal team for an hour on September 18, 2018 at 1pm EDT as they outline a laundry list of what employers, TPAs, brokers, and stop-loss carriers should look for this time of the year – and provide some guidance on how the industry’s players can stay ahead of the curve.
• Breaking the Mold: Creative Solutions for Everyday Problems
  
  August 14, 2018
  Network contracts, stop-loss claims, and intricate medical claim determinations are just a few of the complications that self-funded health plans and their partners need to be able to successfully navigate. Check out our webinar that includes creative solutions for managing these.
• Hottest Industry Trends and Topics – This is What You Asked For
  
  July 12, 2018
  The industry is ablaze! From specialty drugs, to association health plans, to the “right to try” law, we’re all feeling the heat.
• Final Rule on Association Health Plans and YOU: Phia's Take
  
  June 21, 2018
  On Tuesday, June 19th, the Department of Labor issued a final rule on Association Health Plans. Supporters claim the rule will allow millions of Americans to access more affordable coverage options. Critics contend that it will reduce patient access and weaken the insurance markets, leading to increased costs for all. Join The Phia Group's legal team in this special edition webinar in which they will break down the final rule and explain the significant impact it is expected to have on the self-funded industry.
• The Buck Stops…Where? Pointing Fingers in the Self-Funded Industry
  
  June 12, 2018
  In a financial climate where saving money has to be made a top priority, so many entities within the insurance industry have fallen victim to someone trying to shift blame onto them. Regardless of fault, it’s in everyone’s best interests to work together to overcome issues rather than point fingers – but it’s not always that simple.
• The Case for Collusion: How the Power Players May Have Defrauded Us All
  
  May 15, 2018
  At long last, after a lengthy investigation, we are ready to present the allegations of collusion. It is alleged that powerful forces have been working together in a complex scheme to mislead us. To be clear, we are talking about Big Pharma and certain PBMs. A new class action lawsuit has been filed against CVS Health alleging that it knowingly colluded with PBMs to raise generic drug prices. The claim is that health plans and consumers alike have been overpaying for drugs. We have seen this playbook before. This time, however, there is potential for TPAs and their groups to join the lawsuit to recoup funds allegedly overpaid to CVS. Join The Phia Group’s Special Counsels for an hour as they share reports on this alleged fraudulent scheme and discuss the ways in which our industry can fight back and tackle the underlying problem of specialty drug prices.
• 4 Horsemen of the Plan-pocalypse
  
  April 19, 2018
  Nostradamus? Miss Cleo? The Phia Group? In a psychic feat of foresight, The Phia Group’s team has gazed into their crystal ball and identified four issues that may not presently be keeping you up at night, but will certainly be disturbing your slumber very soon. From being forced to pay for surrogate pregnancy and births, to the IRS actively issuing letters notifying employers of 2015 tax year penalties; from a new wave of fraud, errors, and abuse leading to heretofore unseen overpayments, to case law addressing the rights of plans to utilize reference based pricing – you’ve been warned! We predict this complimentary webinar will open your eyes. Miss this webinar at your own peril… You’ve been warned!
• Transparency: Using it to Your Advantage
  
  March 20, 2018
  Join The Phia Group’s legal team as they discuss the need for, and effects of, contractual and price transparency on the self-funded industry – and how health plans, TPAs, and brokers can use transparency to their advantage.
• Evolve or Dissolve – Responding to Today’s Tax Law to Save the Health Benefit Plan Industry Tomorrow
  
  February 27, 2018
  Join The Phia Group's Adam Russo, Ron Peck, and Brady Bizarro as they discuss what you need to know about the new law, and how to navigate the treacherous path that lies ahead.
• Keeping it Under Wraps: What the Networks Don’t Advertise
  
  February 22, 2018
  It’s 2018, and the importance of cost-containment is at an all-time high. Everywhere you look in the self-funded industry is a vendor trying to help health plans control costs; as can be expected, some methods are effective and maximize savings, whereas others…well…not so much
• Plan on Saving by Saving Your Plan – Applying Lessons Learned to Create the Perfect Plan Document
  
  January 30, 2018
  Join The Phia Group’s legal team as they explain the Flagship template, differences from the existing template, and why the Flagship may be right for you.
• A Taxing Time: The Tax Bill’s Impact on Self-Insurance
  
  January 18, 2018
  On December 22nd, President Trump signed a $1.5 trillion tax bill. Among other things, it effectively ends the Affordable Care Act’s individual mandate. It will have a major impact on individual and employer-sponsored health insurance. Millions of Americans may be without health insurance coverage in the coming years. For self-funded plans, this bill may lead to higher costs due to ripple effects across the entire health insurance market while also opening doors to increased cost-containment opportunities. There are other legislative proposals and agency action which could impact our industry, and many states are considering proposals of their own.