Recent Posts

• Don't Be Surprised - Phia's Keys to Success with The No Surprises Act and Appeals Management
  
  August 19, 2024
  As the dog days of summer drag on, the No Surprises Act and its benefactors are feeling the heat. Case volume is overloading the IDR process. Courts are split over whether and how parties can enforce arbitration awards. Payers, including group health plans, are paying nearly four times as much for services as CMS. Combined, this all threatens to undermine the original intent of the law and drive up costs for all. Now, more than ever, it is paramount to understand how these developments impact you and to enact a process to triage billing disputes - separating NSA claims from appeals. Phia is the option for success in this arena. Join our legal team on Tuesday, August 20th, at 1:00 P.M. ET, as we discuss our unique, battle tested processes for handling NSA claims and appeals. From utilizing intelligent out-of-network pricing methodologies and benchmarking to deploying cutting edge appeal review software, we cover all the bases and reveal the best practices for success.
• The Impact of Provider Trends on Stop-Loss and Plans
  
  July 16, 2024
  We progressively find ourselves on the receiving end of both medical provider and legislative efforts to secure more funding from payers. As costs increase, overpriced treatments gain popularity, and fallout from new laws continues to do more harm than good; things aren’t getting less expensive. Stop-loss carriers – responding to these trends – are circling the wagons and implementing new protective measures … but at what cost? Join The Phia Group as they discuss how to counterbalance rising prices as well as navigate these increasingly complex interactions with stop-loss.
• The Cost of Cancer
  
  May 21, 2024
  During the COVID 19 pandemic, experts anticipated that we would see a surge in undiagnosed cancers. That prediction proved to be accurate. Driven by this ongoing issue, on March 8 the Biden Administration announced updates to its “Cancer Moonshot.” Combining efforts to address navigation, research, treatment, costs and coverage – for health benefit plans, this new focus on cancer represents both an opportunity and risk. Cancer and oncology claims have always been one of the most expensive items health plans encounter. Only those who are aware of ongoing developments and plan ahead will minimize risks and maximize beneficial outcomes. Join The Phia Group as they delve into this and other new regulatory and legal developments, including the aforementioned “Moonshot,” the effect of the Dobbs decision on cancer care, specialty drugs, high cost threats – both present and forthcoming, and a very important personal message from Ron Peck.
• Not Surprised – First NSA Analysis Shows That You’re Paying Too Much…And Phia Can Help!
  
  April 25, 2024
  On Dec. 27, 2020, the No Surprises Act (NSA) was signed into law, with an eye towards protecting patients against so-called “surprise” balance bills. The law leaned heavily on “good faith” negotiations between payers and providers, as well as “objective” decision making via independent dispute resolution. Three years later, The Brookings Institution reported that you are paying nearly four-times what Medicare pays (an average of 390%) and are spending at least 50% MORE than an average PPO network. The bottom line? Providers are winning and you are paying MORE now than you did before the NSA’s passage.
• The Skinny on Weight Loss Drugs
  
  February 21, 2024
  From Contrave to Saxenda to Wegovy and beyond, society is being bombarded with messaging about weight loss drugs. While many publicly debate their efficacy and long term viability, far fewer are openly asking who will pay for them – and how. For those of us that sponsor and service health benefit plans, the costs arising from this trend are very real. While we want to help people lose weight, get fit, and improve their overall health – the best way to approach this matter is still uncertain. Join The Phia Group for another free webinar! Our team will discuss this very relevant topic, including related issues such as off-label drug usage, international drug importation, defining medical necessity, plan drafting and exclusions. Likewise, the importance of educating plan membership about the costs of healthcare, and what it means to be self-funded.
• Navigating 2024: The Latest, Most Innovative Plan Design Features & Stop-Loss Policy Updates
  
  January 16, 2024
  In this first webinar of 2024, our crew will provide a rundown of 2024’s biggest plan document and stop-loss updates, including matters about which our team has been asked the most. Stay ahead of the crowd, and join The Phia Group as we jump into the year with a head start. Together we will resolve lingering problems of the past and equip you with a list of changes to expect and topics you need to monitor in 2024 and beyond.
• Strategizing for 2024: New AI Regulations and Transparency Rules Impacting Healthcare
  
  November 15, 2023
  Goodbye 2023, hello 2024. The future has arrived, and we thank you for your efforts to date; the robots will take it from here. Just kidding… maybe? For those who are tracking developments in Artificial Intelligence, this technology is both intimidating and exciting. Regardless of your position on the matter, you won’t be able to escape the meaningful impact A/I will have on our industry. We believe that with the right measures, A/I will be a tool we can use for good in the advancement of our mission to provide the best benefits for the lowest cost. Coupled with other regulatory developments – such as price transparency, a new emphasis on quality metrics, and general public engagement – and 2024 might be one of the best years ever, at least for those who prepare now. Join The Phia Group’s team as they discuss these and other technological and legal improvements that are sure to dictate how you survive and thrive in the coming year.
• Cell and Gene Therapy: Industry and Claim Cost Impact
  
  October 18, 2023
  Drugs are on our mind! In our industry, they are what can make or break the bank. Is this an episode of Breaking Bad? No – It’s American healthcare. From specialty drugs and gene therapy to pharmacogenomics and international drug importation, prices aren’t the only thing getting high. Join The Phia Group’s innovators as they discuss frightening trends in drug costs, define the risks and present solutions you can implement today.
• Choking on the Gag Clause
  
  October 4, 2023
  Whether you’re a health plan, TPA, broker, or anyone else, join The Phia Group’s consulting team leaders as they gather to discuss the prohibition on gag clauses, best practices, and next steps to ensure a gag-free tomorrow!
• A Duty to Serve and Protect … the Plan
  
  August 17, 2023
  Think you can’t be sued for breaching a fiduciary duty? Think again! Lawsuits filed by plan sponsors against their claims administrators are gaining increased media attention. Between talk of a possible recession and passage of new laws such as the No Surprises Act, employers are tightening their belts and examining their partners with renewed vigor. Accusations suggest that anyone managing plan assets has a fiduciary duty to do so prudently. Regardless of fiduciary status, only those who carefully examine claims, manage appeals, navigate disputes, curb plan spending, and leverage all possible sources of reimbursement will likely avoid such scrutiny. Join The Phia Group for another complimentary webinar. Their team will contemplate strategies applicable to every stage in a claim’s lifecycle, and divulge best practices that will keep you out of the court house.
• Illuminated by Phia Ignite! Leveraging A/I and Multifaceted Price and Quality Data
  
  July 11, 2023
  Benefit plans are struggling with the No Surprises Act, are overburdened by disproportionate expenses, and are butting heads with stop-loss over inadequate risk disclosures and network terms. Meanwhile, too many are ignoring modern technology, and are overdependent on cost data while ignoring quality metrics. Join The Phia Group’s leadership team as they present and dissect case studies addressing regulatory compliance, claim appeals, and dispute resolution. From the NSA and IDR, to transparency rules and provider pricing, The Phia Group’s best and brightest will show you a defensible payment strategy with Phia Ignite, as well as determine what role artificial intelligence will play. Drive costs down and address today’s most pressing industry issues by registering for this complimentary webinar. There are sure to be some fireworks!
• The Business of Benefits
  
  May 18, 2023
  Those who service health benefit plans are usually focused on delivering the most robust coverage for the least cost. Yet, all too often we forget that our industry, like any other, only thrives when our own businesses prosper. From adjustments to a post-pandemic environment (and employee populations working remotely from numerous locations), to conflict resolution between entities (such as disputes between plans, stop-loss, and TPAs over reimbursement of fees for savings and management of the NSA), join The Phia Group as we discuss the current events and case studies that will impact whether your own organization sinks or swims.
• Before and After – Examples of Mistakes that Were Addressed and How to Avoid Them
  
  April 20, 2023
  Accidents happen, but they aren’t all inevitable. Often, errors that lead to conflicts and costly outcomes could be avoided. Join The Phia Group’s team as they dig into real case studies, and share examples where The Phia Group was called upon to address some avoidable losses, as well as compare them to scenarios where the proper preemptive steps were taken. This April, remember what Benjamin Disraeli said: "The fool wonders; the wise man asks." Register today for this free and informative webinar!
• Love is in the (Health)Care!
  
  February 15, 2023
  Roses are red, violets are blue, and The Phia Group has some hot tips for you. Whether you sponsor, administer, or service self-funded health plans, The Phia Group’s free webinar will thrill and amaze you. The Phia Group’s team presented a variety of important issues, best practices, and case studies. From disputes with providers, to subrogation, to regulatory updates, and beyond… this webinar is better than a box of chocolates. Don’t wait to unwrap your gift!
• An Omnibus Edition to Kick Off 2023
  
  January 19, 2023
  It’s only January, but 2023 already promises to be a momentous year in healthcare law. From the recent passage of The Consolidated Appropriations Act of 2023—and its inclusion of protections for pregnant and nursing mothers—to regulatory updates regarding the No Surprises Act and manufacturer assistance programs, there’s quite a bit to break down as the new year unfolds. Join The Phia Group’s panel of experts as they discuss how such sweeping changes will impact your group’s health plan.
• A Flip of the Calendar: Looking Ahead to Healthcare in 2023
  
  December 13, 2022
  With a new year comes new developments in healthcare — and 2023 will be no exception. While ever-increasing healthcare costs remain at the forefront of our attention, landmark healthcare legislation — in particular, the No Surprises Act (“NSA”) — continues to cause unforeseen issues for health plans and stop-loss carriers. Additionally, evolving business trends involving mergers, acquisitions, and investments from non-traditional entities promise to impact the industry. Join The Phia Group’s panel of cost containment experts as they look ahead to the challenges and opportunities that await us next year.
• Down the Stretch: Wrapping up a Historical 2022
  
  November 15, 2022
  We are entering the home stretch. With a couple months to go, we can confidently say that 2022 has been one of the most momentous years in the history of American healthcare. The Phia Group’s panel of experts will revisit what they feel were the ten most impactful healthcare developments of 2022, covering a broad swath of topics that includes price transparency (the Consolidated Appropriations Act and No Surprises Act), governance (state laws that preempt ERISA), and equitable benefit coverage (Mental Health Parity and Addiction Equity Act). Who knew one year could have such a profound impact on our industry? Join the fun and find out how impactful 2022 has been.
• The Witching Hour for Healthcare Plans
  
  October 20, 2022
  Quite a few treats are in store for those tuning into The Phia Group’s next webinar, one that will cover some tricky topics. From breaking down regulatory changes impacting the healthcare industry (i.e., mental health parity, discretionary authority) to developments concerning plan drafting language, Phia’s roundtable of experts will keep you in the know. Oh, and did we mention that there’s also going to be a discussion of what to expect from a health policy standpoint in next month’s midterm elections?
• A Prescription for Success? The Unknown Impact of Recent Legislation on Prescription Expenses
  
  September 15, 2022
  The Inflation Reduction Act, signed into law by President Biden last month, includes provisions to lower prescription drug prices for Medicare recipients. But what about most Americans who are on employer-sponsored plans? Could they be adversely affected by pharma companies potentially elevating prices in response? In its next webinar, The Phia Group takes a deeper dive into the residual effects of this landmark act on your plan—as well as how the recent Johnson & Johnson lawsuit involving patient assistance programs may heighten the risk for companies using such PAPs. For good measure, Phia’s panel of experts will also provide an update on final rules just released regarding the No Surprises Act.
• Supreme Decisions – A Proactive Approach for Health Plans to Dobbs and Marietta
  
  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.
• Fiduciary Liability & The No Surprises Act | The Phia Group
  
  May 24, 2022
  View our full webinar with a candid roundtable discussion on what the Fiduciary Liability and No Surprises Act is and how they continue to evolve.
• Healthcare Opportunities and Concerns | The Phia Group
  
  April 19, 2022
  Learn about case studies and recent developments in the healthcare industry from relationships to regulations, from plans to politics and more.
• The 11th Hour - Last Minute Moves to Make for 2022 as a New Era in Cost Containment Begins
  
  December 13, 2021
  Learn about what the new era of cost containment will bring in 2022 and how to prepare for increased regulatory attention and enforcement.
• A Spooky Surprise: NSA Regulations on IDR Released
  
  October 19, 2021
  Are you aware of the No Surprises Act rules on independent dispute resolution? Learn about its implications for claims and appeals with The Phia Group.
• The Provider Perspective – Analysis and Response to How Providers are Reacting to Recent Rule Changes and Reform
  
  August 24, 2021
  Are you prepared for the new healthcare pricing rule changes? Learn about best practices to fight back against abusive provider billing tactics.
• Surprise, surprise! Analyzing the No Surprises Act Part Deux
  
  July 12, 2021
  Wondering how surprise billing regulations will impact you? Learn about the No Surprises Act in this detailed analysis of the new rules by The Phia Group.
• Back on Track: Plan Sponsor Priorities for the Second Half of 2021
  
  June 21, 2021
  Learn about cost containment solutions to help you prepare for challenges with mental health parity requirements and rising prescription drug prices.
• Face the Change – Plan Design, Administrative Claims Processing and Payment Changes Needed in Light of COVID-19 and New Regulatory Obligations
  
  April 27, 2021
  Learn about ARPA, COBRA, Mental Health Parity, the No Surprises Act and how to remain compliant in light of new federal and state regulations.
• 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.
• 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.
• 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.