The No-Network Plan: As it relates to the implementation and administration of a non-PPO, alternative-pricing system, The Phia Group has provided advice and drafting services regarding language and layout of SPDs, ID cards, EOBs, correspondence to members and providers on behalf of a self funded plan administered by a TPA. Phia has been a key contributor to the apparent market shift in cost-containment services focusing on fee schedule based carve-outs, narrow networks, or even no-network reference based reimbursement models.
In all cases, we’ve found that the solutions lie in preparation, not reaction. If you negotiate with providers before they treat patients, add language to plan documents and ID cards before claims are incurred, and educate clients and their employees, your results will be much better than if this is “sprung” on everyone post-service. Phia advised in this area and provided plan guidance of the “do’s and don’ts” of non-network arrangement implementation.
Our capabilities in this regard related to document and correspondence drafting, guidance when dealing with situations on a case by case basis, attempting to resolve balance billing disputes that cannot be resolved in-house, and providing reference to litigation counsel (if necessary) when a conflict cannot be resolved without legal action. After one year of implementation of this reimbursement methodology one such plan covering approximately 100 lives has experienced a reported savings of nearly $200,000 for the first year of the program.
||More than $200 PEPM
|Phia Intervention Saved: