The Phia Group Blog

From the February 18, 2016 EBIA Weekly [Health Care Serv. Corp. v. Methodist Hosps. of Dallas, 2016 WL 530680 (5th Cir. 2016)] Available at http://www.ca5.uscourts.gov/opinions/pub/15/15-10154-CV0.pdf The Fifth Circuit has ruled that a third-party administrator (TPA) of employer-sponsored self-insured health plans…

By Jason Davis Where to gather to discuss reference based pricing (RBP), you will have three opinions. Read more…

MyHealthGuide Source: William H. Payne IV and René E. Thorne Case: Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, Supreme Court Ruling The U.S. Supreme Court has narrowed, ever so slightly, the ever-changing definition of…

MyHealthGuide Source: Emily M. Scott As more patients join self-funded plans, hospitals face new challenges regarding billing and collection. The Chargemaster Challenge The increase in self-funded employer health plans has triggered an unintended consequence for hospitals with respect to payment…

MyHealthGuide Source: Adam Russo, Esq.,1/14/2016, Thompson Information Services Blog In order for reference-based pricing (RBP) to work, health plan sponsors should do it in a way that involves implementing best practices for cost analysis, claim repricing, plan design, patient advocacy…

By Carmen Castro-Pagan An out-of-network health-care provider can’t continue with her claims under the Employee Retirement Income Security Act for unpaid benefits, fiduciary breach and failure to disclose documents against four health benefit plans, the U.S. Court of Appeals for…