The Phia Group’s 3rd Quarter 2025 Newsletter
The Phia Group is off to a great start in the third quarter of 2025! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.
| ||
| ||
| 
| |
|
| ||
|
|
The Book of Russo: It’s hot here in Canton, Massachusetts. Of course, I recognize “hot” is a subjective term. I laugh when the local meteorologist warns us that – here in New England – we are under a heat wave advisory, that cooling shelters will be opened all over the state, and to more or less flee for our lives… because it’s been 90 degrees for 3 consecutive days!!! (Yikes!) I’m always reminded by our friends elsewhere around this amazing nation of ours that 90 degrees is a mild March in Dallas. Or, how about Little Rock where temperatures have exceeded 90 degrees for 40 days straight!!! | |
|
It proves that sometimes your reality is just that – yours! Understanding subjective experiences versus universal objective truths is a key to understanding others… Others’ needs, hurdles, and solutions. And when it comes to self-funding our health plans, these days, some realities are objectively true – and worrisome – for all of us. Medical costs are soaring, claims are getting more complex, denials are on the rise – and as a result – appeals and no surprises act (NSA) disputes are on the rise as well. As costs climb, so too do deductibles, premiums, and co-pays. This all, in turn, makes us all look pretty bad. Sweating yet? In the face of this objective reality, brokers, advisors, and consultants are looking more vigorously than ever before for “hot” ways to improve the status quo. That’s where The Phia Group comes in! You want a better way to deal with appeals? You want to ensure their timely handling, accurate decisions, and improved NSA dispute removal from the appeals process? BETTER CALL PHIA! (That doesn’t really work if it doesn’t rhyme…) Speaking of the NSA, you want to lower your out-of-new claim expenses, improve NSA handling and IDR case victories? BETTER SEE A PHIA! (Not sure if that’s any better…) Between accurately calculating maximum payable amounts based on cutting edge plan terms – in a way that is unbelievably defensible and backed by an unrivaled team of negotiators, plan advocates and legal experts – our clients are enjoying an average reduction off of billed charges in the neighborhood of 80% decreases … compared to national wrap network savings of 35%… I’m objectively impressed. You want to identify more opportunities to ACTUALLY secure reimbursements from liable third parties… thereby increasing your plan recoveries? Recoveries are objectively more important than opportunities alone… and we STILL have a “Passion for Subro!” Let us help you change your reality for the better. Let’s heat things up together; it will be cold out there soon enough! I’m proud to be the CEO and co-founder of Phia. Come and find out why. Happy reading!
| ||
| ||
|
Service Focus of the Quarter: Subrogation & Recovery Services
Subrogation might not be flashy, but it’s one of the most powerful ways to return dollars directly to the plan. The Phia Group’s Subrogation & Recovery Services combine advanced case-finding technology with legal and investigative expertise to ensure that every viable opportunity is pursued. From auto accidents to mass torts, Phia identifies recoveries that others miss. For health plans looking to maximize recoveries without lifting a finger, this service delivers measurable results with minimal disruption. Plans benefit from real-time tracking, tailored integration with plan language, and a member-sensitive approach that avoids noise while driving results. The Phia team works closely with TPAs to ensure clean coordination and fast turnarounds, even in complex scenarios involving stop-loss or disputed liability.
Enhancement of the Quarter: PDM 2.0 (Coming Soon!) Get ready to turbocharge your plan document drafting workflow with PDM 2.0! We’ve completely rebuilt the engine – including harnessing AI-driven technology – to deliver lightning-fast performance and a smoother, more intuitive interface. Jump between sections in a flash with our new expand/collapse navigation, plus a much-requested auto-save feature, so you can focus on creating the perfect plan design without letting distractions derail your train of thought. Coming in 2026, PDM 2.0 will adapt to your unique needs with powerful customization tools, such as Tables of Contents and benefit grids that can be tailored to your specifications. And when it’s time to collaborate, our client dashboard keeps your team in sync by showing exactly who’s using which templates, and for which groups. Beta testers are already raving about how intuitive and efficient everything feels, and as a thank-you for your loyalty, existing PDM clients will enjoy these premium features at today’s rates throughout 2026. Stay tuned for more updates and get ready to experience plan drafting like never before! Phia Case Study: The IDR Entity That (Gasp!) Got One Wrong Many of you may be thinking, “Wait, what?! An IDRE made an error? That can’t be right, can it?” Well, believe it or not, it happened. Our Provider Relations team fielded an IDR request from a medical provider on behalf of a TPA. The request was originally sent to the wrong email address; though it was an email address maintained by the TPA, it was not the email address that the TPA explicitly provided for this purpose. The IDRE subsequently issued an award to the provider, even though the plan was not given the opportunity to make its own case. Attorneys in Phia’s Provider Relations department got in touch with the IDRE and informed it that the regulations specifically deem an IDR initiation invalid if either (1) open negotiations have not been commenced and tolled, or (2) the IDR request is sent to an address other than the one the plan has specifically designated for this purpose. Since both of these things occurred here, the IDR request itself was invalid, and therefore the award was similarly invalid. After a number of conversations between Phia’s team and the IDRE, the latter finally voided its prior award (much to the provider’s dismay). Though applicable law and regulations do not provide an explicit way to challenge an IDR award, our team knows just the right buttons to push to make sure that they are heard.
Fiduciary Burden of the Quarter: Fee Disclosures – Explain, or Die Trying Health plan fiduciaries aren’t required to use the cheapest vendor – but they are required to explain why the plan pays the vendor’s fees, and why that amount is reasonable for the services provided. In a DOL audit or courtroom, “we don’t know” or “our broker recommended them” isn’t a good defense. Plans should make sure they request a complete fee disclosure from any vendor receiving plan funds, including admin fees, commission splits, pass-through payments, or any other “direct or indirect” compensation (which sounds very broad, because it is!). Then, we recommend keeping a short write-up on file: what the fees are, what services they cover, how the vendor was chosen, etc. There’s no requirement to renegotiate or shop around every year, but if a plan can’t show that it’s paying only reasonable fees, that’s a fiduciary problem.
• On May 15, 2025, The Phia Group presented “Mental Health Parity Under Trump: Navigating Compliance in a New Era,” in which we discussed President Trump’s executive order to cap all prescription drug prices. • On April 10, 2025, The Phia Group presented “Proceed with Caution: A.I. Has Forever Changed Healthcare – but at What Cost?,” in which we discussed considerable ethical concerns such as algorithmic bias and data privacy violations when A.I. meets healthcare. Empowering Plans • On June 20, 2025, The Phia Group presented “Saying What You’re Thinking,” in which our hosts, Corey Crigger and Ron Peck, discussed some of the things many in our industry seem to be thinking, but are often afraid to say aloud. • On June 4, 2025, The Phia Group presented “Algorithms and Adjudication: How AI Is Affecting the Self-Funded Industry,” in which our hosts, Jon Jablon and Kendall Jackson, discussed the integration of AI into the self-funded industry. • On May 21, 2025, The Phia Group presented “Executive Orders, Tariffs, and a Crystal Ball,” in which our hosts, Bryan Dunton and Cindy Merrell, discussed President Trump’s latest moves to address the rising cost of prescription drugs. • On May 8, 2025, The Phia Group presented “Unreasonable Plan Fees on Trial: Cunningham v. Cornell University,” in which our hosts, Brady Bizarro and Brian O’Hara, discussed the Supreme Court’s unanimous decision in Cunningham v. Cornell University. • On May 1, 2025, The Phia Group presented “The Most Exciting Two Minutes in Cost Containment,” in which our hosts, Corey Crigger and Cindy Merrell, discussed the event that takes over their city once a year! • On April 22, 2025, The Phia Group presented “Why 2025 is the Year to Go Self-Funded,” in which our hosts, Jennifer McCormick and Kelly Dempsey, discussed what factors are driving employers to consider self-funding, the pros and cons of self-funding, and some of the major differences employers will encounter. • On April 8, 2025, The Phia Group presented “Plan Sponsor Discretion Advised,” in which our hosts, Ron Peck and Nick Bonds, discussed ERISA fundamentals and how to really embrace fiduciary status and properly exercise discretionary authority.
Be sure to check out all of our latest podcasts!
• BenefitsPro – Beyond GLP-1s: Why seafood might be a key to affordable obesity management – June 2025 • Investopedia – This Remote State Has the Most Affordable Health Insurance: See How Yours Stacks Up – June 2025 • BenefitsPro – Compliance checklist 2025: Key issues for self-funded health plan sponsors – April 2025
• Tiara Yachts v. BCBS Michigan: A Cautionary Tale. When it comes to self-funded health plans, fiduciary duties often tend to lurk in the background. • Cunningham et. al. v. Cornell University: A Fascinating Interpretation of ERISA. For fiduciaries of health and retirement plans, things have gotten more complicated. • Tariff Talk – How Trump’s Pharmaceutical Tariffs Could Impact You (and How You Can Prepare). How will Trump’s tariffs impact the cost of pharmaceutical drugs? • Navigating Mental Health Parity: What Self-Funded Plans Need to Know. Here’s what you need to know about the MHPAEA. • A Discussion of the Executive Order to Lower Drug Prices. Are lower drug prices coming? To stay up to date on other industry news, please visit our blog.
At The Phia Group, we value our community and everyone in it. As we grow and shape our company, we hope to do the same for the people around us. The Phia Group’s 2025 charity is the Boys & Girls Club of Metro South.
The mission of The Boys & Girls Club is to nurture strong minds, healthy bodies, and community spirit through youth-driven quality programming in a safe and fun environment. The Boys & Girls Club of Metro South (BGCMS) was founded in 1990 to create a positive place for the youth of Brockton, Massachusetts. It immediately met a need in the community; in the first year alone, 500 youths, ages 8 to 18, signed up as club members. In the 30-plus years since then, the club has expanded its scope exponentially by offering a mix of Boys & Girls Clubs of America (BGCA) nationally developed programs and activities unique to this club. Since their founding, more than 20,000 youths have been welcomed through their doors. Currently, they serve more than 1,000 boys and girls ages 5-18 annually through the academic year and summertime programs.
Hygiene Drive Proper hygiene and cleanliness is such an important part of adolescents’ and teenagers’ daily lives – especially in the upcoming summer months. As part of their ongoing dedication to The Boys & Girls Club of Metro South, The Phia Group’s employees over the past month donated hundreds of hygiene and sanitation products to support club members. We are so proud of our employees coming together to help this wonderful organization.
Adam on the Air! On Monday, June 9, 2025, Adam V. Russo’s first episode of his new radio show, “Health Cent$ with Adam V. Russo, Esq.,” aired on Healthcare NOW Radio! Listen in using the following link: https://www.healthcarenowradio.com/.
In early April, Phia held a BBQ to celebrate Cleveland’s Opening Day, as well as Adam’s birthday! A day we all look forward to celebrating at Phia!
Kentucky Derby Day As is tradition, Phia held its annual Kentucky Derby Day. The Phia Family in our Canton office dressed up to make sure we showed support to our Louisville team!
Easter at Phia The Phia Family in Louisville celebrated Easter with the Easter Bunny, who set up an Easter Egg hunt for the whole office!
Get to Know Our Employee of the Quarter: Nathan Cook Being named Employee of the Quarter is an achievement that is for Phia employees who truly go above and beyond their responsibilities. This person must not only transcend their established job description but also demonstrate such unparalleled dedication and passion to The Phia Group and its employees that it cannot go without recognition. The Phia Explore team unanimously agrees that there is no one more deserving than Nathan Cook to be recognized as The Phia Group’s Employee of the Quarter for Q2 of 2025.
Congratulations, Nathan, and thank you for your ongoing and future contributions.
Phia Attending the SIIA National Conference Several of Phia’s industry experts will attend SIIA’s 2025 National Conference in Phoenix, Arizona, from October 12th – 14th. If you are interested in attending or learning more about SIIA’s National Conference, visit their website: https://www.siia.org/i4a/calendar/?pageid=7767&showTitle=1
• Recovery Service, Onboarding and Support Specialist • Client Success Account Executive • Accounting Administrator • Sr. Administrative Assistant • Sr. Manager, IT Infrastructure • Principal Cloud DBA & Architect • Remote P/T Customer Service Representative See the latest job opportunities, here: /about/careers/ Promotions • Emily King has been promoted to NSA Claim Specialist • Elise Mulready has been promoted to Case Handler • Joanna Marden has been promoted to Training and Auditing Specialist • Samantha Canestraro has been promoted to Training and Auditing Specialist • Larry Moffett has been promoted to Training and Auditing Specialist • Brittany Farr has been promoted to Team Lead, Customer Service
New Hires • Andrew Beauchamp was hired as a Sr. Contested Liability Claim Recovery Specialist • William Smith was hired as a Plan Drafter • Zoe Georgenes was hired as a Staff Accountant II • Leslie Decker was hired as a Sr. Contested Claim Recovery Specialist • Jessica Nabstedt was hired as a Sr. Contested Liability Claim Recovery Specialist • Sheena Roberts was hired as a Sr. Contested Liability Claim Recovery Specialist • Destiny Chandler was hired as a Case Investigator • Kenneth Fusting was hired as a Sr. Contested Claim Recovery Specialist • Sarah Blandford was hired as a Sr. Manager, Recovery Services Onboarding and Support • Kara Shields was hired as a Claims Specialist • Zoe Harris was hired as a P/T Correspondence Coordinator • Connor Wong was hired as an Accounting Administrator I • Joseph Maloney was hired as an Accounting Assistant • Jonathan Ingraham was hired as an Accounting Administrator • Alexa Graves was hired as a Plan Drafter • Venessa Ordonez was hired as a PACE Appeals Specialist • Rama Yadav was hired as an ETL Developer • Molly McMenamin was hired as a Project Coordinator
The Phia Group Reaffirms Commitment to Diversity & Inclusion At The Phia Group, our commitment to fostering, cultivating, and preserving a culture of diversity and inclusion has not wavered from the moment we opened our doors 20 years ago. We realized early on that our human capital is our most valuable asset, and fundamental to our success. The collective sum of individual differences, life experiences, knowledge, inventiveness, innovation, self-expression, unique capabilities, and talent that our employees invest in their work, represents a significant part of not only our culture, but also our company’s reputation and achievements. We embrace and encourage our employees’ differences, including but not limited to age, color, ethnicity, family or marital status, gender identity or expression, national origin, physical and mental ability or challenges, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. The Phia Group’s diversity initiatives are applicable to all of our practices and policies, including recruitment and selection, compensation and benefits, professional development and training, promotions, social and recreational programs, and the ongoing development of a work environment built on the premise of diversity equality. We recognize that the success of our company is a direct reflection of each team member’s drive, creativity, diversity, and willingness to exercise initiative. With this in mind, we always seek to attract and develop candidates who share our passion for the healthcare industry and our commitment to diversity and inclusion.
| ||
| ||
