Our Proven Cost Containment Results
Explore real success stories showcasing how The Phia Group delivers measurable savings and impactful results for clients. These are more than just case studies; they’re proof of our unwavering advocacy for plans and families.
Phia Unwrapped & NSA
This case involved an urgent need to secure a Single Case Agreement (SCA) for a critically ill patient transitioning from the ICU to a long-term acute care facility. With out-of-network barriers and a highly compressed timeline, Phia acted immediately to…
This negotiation involved two related inpatient claims for the same patient and provider. Phia adopted a strategic approach by linking both claims into a single settlement and proposing a uniform percentage reduction to incentivize agreement. To support the recommended…
This high-billed inpatient claim showed early signs of NSA ineligibility due to untimely initiation of Open Negotiation. After closely examining the EOBs, payment timelines, and mailing details, Phia identified discrepancies that suggested the provider had not met NSA deadlines. …
This neonatal professional services case involved multiple weeks of treatment and numerous disorganized claims filed by the provider. The client grew concerned as deadlines approached and the provider continued submitting inconsistent, overlapping Open Negotiation notices. Instead of accepting the…
This high-value claim involved uncertainty over whether services qualified as emergent under the NSA. After collaborating with the client and determining that IDR was the best course of action, Phia carefully reviewed the incoming dispute notice. Phia immediately identified…
This No Surprises Act negotiation centered on a high-dollar emergency claim accompanied by an aggressive provider reimbursement demand. Phia applied a firm; informed negotiation strategy rooted in NSA payment standards and reasonable reimbursement expectations. Through persistent outreach and confident,…
A set of No Surprises Act emergency service claims escalated to Independent Dispute Resolution (IDR), with the provider seeking elevated reimbursement based on alleged patient acuity and extensive services rendered. Leveraging deep clinical experience and firsthand understanding of care delivery,…
Phia received a request from a newly minted Unwrapped client requesting a mental health therapy SCA for a member who had been admitted as an urgent case and was continuing treatment. The claims forms provided to Phia for review were…
An Unwrapped client of Phia’s had a patient whose parents wanted him to see an out-of-network vendor to continue care for autism. Even though there were several facilities in the area covered by the client’s in-network solution, the parents were…
An Unwrapped client requested that The Phia Group secure a Single Case Agreement (SCA) for a patient undergoing long-term treatment for post-traumatic stress disorder (PTSD). The patient had been receiving weekly care from an out-of-network mental health provider for over…
Subrogation & Recovery Services
This overpayment recovery presented notable challenges due to repeated provider denials and a complicated Medicare Secondary Payer (MSP) issue. While the provider insisted the plan was primary, Phia independently identified a narrowly applicable Medicare exception tied to the member’s status….
A nonprofit organization that provides programs to underserved communities in California, through its TPA, recouped the maximum allowable amount per applicable state law by using The Phia Group’s subrogation services. A member of the nonprofit organization’s self-funded health plan suffered…
A TPA using The Phia Group’s subrogation services recouped funds the plan had advanced for a chronic medical condition caused by mold in a plan member’s home. The member pursued claims against various parties, including an air conditioning manufacturer, installer,…
A Native American Indian tribe, through their TPA, secured a recovery by using The Phia Group’s subrogation services when the plan member’s attorney refused to acknowledge the Plan’s right of recovery from the proceeds of a third-party liability settlement. More…
PACE®
A self-funded health plan received a second-level appeal from a participant after initial and first-level denials for an expensive out-of-network procedure. The claim had been denied based on plan exclusions for experimental and investigational treatments and lack of medical necessity….
A self-funded health plan received an appeal from a participant who was denied reimbursement for out-of-network mental health treatment due to a lack of prior authorization. The member explained that in-network providers had wait times exceeding six weeks, and the…
A Plan Sponsor of a self-funded plan was billed over $1,000,000 for a newborn baby and care rendered by an in-network hospital provider (Provider). The claim charges resulted in the member exceeding the specific deductible for the member and the…
Care Empowered Pricing®
This case involved two high-balance hospital claims already placed with separate collections agencies, both of which refused to negotiate and incorrectly asserted emergency service exceptions. Phia obtained and analyzed billing documentation, identifying clear grounds for No Surprises Act protection. …
A referral for a VIP member was received by Phia’s balance bill intake team, totaling an amount of over $68k. After the initial allowable, the outstanding balance remaining was north of $38k. With VIP members, all parties are heavily involved…
Air ambulance providers are often challenging to negotiate with due to consistently high charges. An air ambulance provider initiated an Open Negotiation under the No Surprises Act (NSA) with a Phia client. Historically, air ambulance entities offer minimal concessions (typically…
A client engaged Phia to assist with a claim that had progressed to the final stages of the No Surprises Act (NSA) process. Open negotiations had been completed, and the Independent Dispute Resolution (IDR) filing had already occurred. The IDR…
ICE
A TPA presented The Phia Group with a complex fact pattern about an employer’s responsibilities related to an employee’s FMLA leave and potential need to offer COBRA. The Phia Group reviewed and dissected each step of the fact pattern to…
A broker servicing a self-funded plan asked whether a plan’s hazardous activities exclusion could be utilized to deny a very large claim incurred as a result of injuries stemming from hang gliding. The Phia Group issued a consulting opinion, which…
We received an urgent consulting question from a client with a VIP plan member who was asking whether he would be able to add his spouse to the group health plan mid-year once she immigrated to the U.S. on a…