Webinars

Recent Posts

• A Network by any Other Name
  
  June 22, 2017
  PPOs, EPOs, HMOs… The days of simple network categories is past. Today, innovative providers are offering up-front transparent pricing, subscription-based direct primary care (DPC), value based pricing, ACOs, medical tourism, international prescription plans, on-site clinics, telemedicine and direct contracting with “centers of excellence.”
• Decisions, Decisions: Which Plan Types Work Best for Which Groups, and Why?
  
  May 16, 2017
  Between a traditional PPO plan, a MEC or “skinny” plan, reference-based pricing, narrow network, cafeteria plan, or high-deductible health plan, who can choose? They all have their nuances, and which plan type is best for a given plan sponsor will depend on factors including risk tolerance, geographical location, employee base, and more.
• The Double-Edged Sword of Discretion: How Even Great Plan Document Language Can Cause Gaps in Coverage
  
  April 27, 2017
  Nearly all Plan Documents have some mention of discretionary authority. The ability to interpret the terms of the plan is necessary to receive deference from the courts, and is needed since not every conceivable scenario can be planned for within the plan document.
• Medical Bill Blues: Pre-Payment Contracting and Negotiation, Pricing Alternatives, and Post-Payment Recovery of Overpayments
  
  March 23, 2017
  It’s common knowledge that not every network contract adds real value, nor can medical providers always be relied upon to bill responsibly. As the fiduciary duty to be prudent with plan assets becomes increasingly relevant, it's important that self-funded health plans, and those who service them, not fall behind.
• Top Miscues Employers Make When It Comes To Their Health Plans ... And What We All Can Do To Become Health Plan Heroes
  
  February 15, 2017
  Employers who self-fund their health plan act as a traditional employer, a plan sponsor, and a plan administrator. Juggling this many roles, conflicts and contradictions are bound to happen. For instance, an employee handbook’s handling of disability leave may conflict with the health plan document as it relates to employment and plan coverage.
• Back to The Self-Funding Future – Which Echoes of 2016 Will Continue to Impact Self-Funding in 2017
  
  January 19, 2017
  The past decade has ushered in both outrage and opportunity for self-funded plans, and 2016 was no different. The characteristics of self-funded plans continued to alter in concert with new laws and regulations. While these bureaucratic efforts often hindered our ability to self-fund, for those daring enough to change with the times, we saw increased growth and prosperity. We will no doubt see these issues and opportunities continue to evolve in 2017, and only those that prepare will thrive.
• Changes to The Phia Group's Reporting Portal
  
  January 4, 2017
  Staying true to its mission of reducing the cost of healthcare through the use of innovative technology, The Phia Group is proud to announce new advancements now available to our clients, via The Phia Group’s reporting portal.
• 2017 Phia Forecast
  
  December 13, 2016
  2016 has been another huge year for self-funding, and a year of significant change for healthcare in general – and with the results of the recent presidential election, 2017 is slated to be an exciting year as well. 2016 has played host to all sorts of new federal regulations, state laws, market trends, and cost-containment options, and we expect 2017 to be even more unpredictable…but still great for self-funding.
• The First 100 Days: President-elect Donald Trump, Healthcare, and Self-Funding
  
  November 21, 2016
  The election is behind us, and no matter who you supported, it was one of the most divisive in recent history. Regarding the contentious topic of healthcare, President-elect Donald Trump has promised to repeal the Affordable Care Act and replace it with a better, more efficient system. The future of our industry is sure to change.
• The Good, The Bad, and The Ugly – Ethics: Simple Mistakes vs. Breach
  
  November 15, 2016
  As the Department of Labor hones in on what is ethical (or unethical) and what constitutes fiduciary liability, plan administrators, third party administrators, brokers, and various advisors who service self-funded plans must make a renewed effort to ensure that their actions are in compliance with current legal and ethical standards. All self-funded entities must take steps to avoid actions that may be deemed unethical or in violation of their considerable responsibilities - and even when exercising good faith, it is still possible to act unethically.
• How Low Can You Go? Managing Specialty Drugs, Reducing Overall Pharmacy Spend, and Unraveling the Mystery Behind PBMs
  
  October 27, 2016
  Pharmacy Benefit Managers, or PBMs, are an important factor in the cost and value of self-funding - yet many TPAs, brokers, and plan sponsors feel it is impractical to even look into changing the status quo. Self-funded plans and those who service them, however, should be constantly on the lookout for effective alternatives to their current procedures - especially in this aggressive economic and legal climate.
• Independent Consultation & Evaluation: ICE, ICE, Baby!
  
  September 22, 2016
  Our industry is plagued by issues related to compliance, contracts, and cost-containment – and a myriad of other legal issues as well. Engaging an expert for a second set of eyes is a chore in itself, requiring approval from management or an individual group as well as a cost-benefit analysis of the expert’s fees – sometimes resulting in the decision not to consult a neutral third-party at all.
• Unwrapping Your Wraps
  
  August 23, 2016
  Wrap networks provide plans with discounts off billed charges for claims that don’t fall within the plan’s primary network. But do these wraps really add value? With skyrocketing provider charges and static discounts off of those charges, the modern-day wrap network doesn’t seem to provide much help when it comes to claims costs.
• Back to Basics: Plan Documents 101 (Part 2)
  
  July 13, 2016
  When we think of hot topics in the self-funded industry, plan document drafting is hardly the first thing that come to mind. Instead, issues such as fiduciary duties, reference-based pricing, transgender coverage, employee incentives, and provider abuse are on the tip of everybody's tongues. All these topics, however, share a common feature: they're all reflected, in some way or another, within the plan document. Without compliant and effective plan document language, a plan can't offer robust benefit programs while containing costs.
• Back to Basics: Plan Language 101
  
  June 15, 2016
  Most situations that involve self-funded benefit plans revolve around language within the plan document. Whether deciding if a service is experimental, or figuring out whether a dependent is actually covered, or deciding whether a leave of absence will extend coverage, the plan document controls in just about all situations. For that reason, it's all the more disastrous when poor plan language handicaps plans and TPAs. Like we always say, your rights are only as good as your language.
• The Tangled Web of Contracts
  
  May 12, 2016
  The self-funded industry is made up of a complex system of contracts, and navigation across them is anything but simple. Network contracts supersede plan documents; Administrative Services Agreements “add” plan provisions, stop-loss policies embrace carve-outs but networks prohibit them, employee handbooks promise benefits not provided by the SPD…and those are just a few examples of areas of confusion. Thank you for joining The Phia Group on May 12th, 2016 as its legal team gave a crash course in contracts. Cost-containment can be impacted by the contracts you sign, and there are often exceptions and restrictions buried deep down, or potential issues not considered beforehand. In this webinar, The Phia Group explained some of the contracting pitfalls experienced on a daily basis within the self-funded industry.
• Unraveling FAQ Part 31
  
  May 4, 2016
  Reference-based pricing is unquestionably a hot topic in the self-funded industry today. So hot, in fact, that the federal government has taken an active interest in it for the third time now; in its latest FAQ, published just last week (FAQs about Affordable Care Act Implementation, Part 31), the regulators reiterate concerns regarding network adequacy and how it relates to - and regulates - reference-based pricing arrangements.
• A Changing Industry: Navigating the current (Events)
  
  April 14, 2016
  The self-funded industry changes rapidly and without notice. In recent memory, the biggest culprit has been the ACA - and in its aftermath, there have been numerous regulatory guidelines and court cases that have helped interpret the ACA's provisions. Still, though, there are many other changes occurring at any given time. Examples include assignments of benefits, discrimination, preemption, bankruptcy, subrogation, stop-loss, and more.
• The Replacements
  
  April 8, 2016
  As the self-funded industry evolves, benefit plans are forced to evolve with it or get left in the dust. Employees need quality coverage – but providing robust yet affordable programs has proven difficult for many self-funders. This conundrum can be addressed by changing inefficient or archaic processes; in response to contractual handcuffs limiting your ability to target cost drivers, too many health plans and TPAs overreact, thinking that the solution is to trash their plan entirely, and to try something new and untested – trading security for savings. When it comes to benefits, don’t remove, don’t reduce... replace! Avoid the extreme sides of the spectrum, achieve balance, and ensure your own viability with “The Replacements.” Thank you for joining The Phia Group on Tuesday, February 16th, as we identified the trouble spots found in all benefit plans, and helped develop strategies to carve them out and replace faulty portions with new alternatives – without harming the rest of the plan!
• Saving Stop-Loss - Protecting a Key Self-Funding Ingredient in a Hostile World
  
  January 19, 2016
  Thank you for joining The Phia Group’s legal team on Tuesday, January 19, 2016, as they provided first-hand insight into the self-funded market’s reliance on stop-loss and threats to that industry, including what TPAs and brokers should look for – and look out for – when advising health plan sponsors regarding stop-loss options.
• Issue of the Year: Reference-Based Pricing and Balance-Billing
  
  December 28, 2015
  Thank you for joining The Phia Group’s legal team on December 15th as they discussed reference-based pricing and balance-billing from the ground up and debunked common myths associated with it. This webinar will ended the year with a comprehensive primer on reference-based pricing and balance-billing, the rights of all parties involved, and what you can do to be proactive and successfully administer a reference-based pricing program.
• Keeping PACE With The Trends
  
  December 7, 2015
  Thanks for joining The Phia Group’s legal team on November 30th as we explored the numbers behind our industry’s growth and provided real-world discussion on the topic, while we explored real solutions to the issues presented.
• A Call To Action!
  
  October 15, 2015
  Thanks for joining The Phia Group’s legal team on October 14th as we discussed many such ongoing instances, and shared with you opportunities to take an active role in the preservation of our industry.
• "Phia Case Studies" - When Silence is Loud and Assumptions Mean Disaster
  
  August 4, 2015
  Thanks for joining The Phia Group’s legal team on September 17th, at 1:00 PM EST, as they analyzed recent cases featuring communication breakdowns, regulation popping up in its wake, and best practices to make sure you know your role and do your job.
• "Stories From The Front Lines" - Real Wins, Losses, & Difference Makers
  
  May 20, 2015
  Join The Phia Group on Wednesday, May 20th, from 1 to 2 PM EST, as its attorneys discuss their experiences providing plan administrators with guidance as it relates to difficult claim processing decisions, conflict resolution, and bill negotiation… as well as dissect the small factual differences between otherwise similar scenarios that made all the difference.
• "Survival of the Fittest" - Best Practices to Perfect a Modern TPA
  
  April 23, 2015
  Join The Phia Group’s legal team as they discuss the best practices for TPA’s and how this can help you!
• "To Be Or Not To Be"... A Fiduciary - Do You Even Have A Choice?
  
  March 25, 2015
  Being a fiduciary is serious business. Determining whether you are one can also be very complicated. Case law increasingly establishes that being a fiduciary has more to do with the action one takes, than the contract one signs. Entities working on behalf of self-funded benefit plans may be unknowingly taking on fiduciary status. Are you a fiduciary? What are the advantages and disadvantages of taking on that burden? What can you do to protect yourself?
• Pushback & Counter-Attack
  
  February 12, 2015
  Pushback & Counter-Attack – How attorneys, providers, and the government are combating your efforts to contain costs… and what you should be doing about it!
• IMPLANT WARS!
  
  January 14, 2015
  IMPLANT WARS: How monitoring provider self-referrals, & negotiating based on actual costs can result in major plan savings!
• "In Reference To The FAQ"... The DOL FAQ Dissected - Part Deux!
  
  November 20, 2014
  Join The Phia Group’s CEO, Adam V. Russo; Sr. VP & General Counsel, Ron E. Peck; and other members of the legal team as we continue to dissect the FAQ, its key provisions, and how it impacts “RBP Plans .
• Creeping Around Pitfalls on the Way to Scary Savings? - How to Avoid Horror When Implementing Cost Containment Schemes
  
  October 30, 2014
  DON’T MISS OUT! Whether you’re embarking on a new cost containment adventure in-house, or with the help of a vendor, most programs are not simple “plug and play” affairs. Those who head into the dark unprepared will undoubtedly find themselves spooked by what hides around the corner.
• Plans For The Future
  
  September 24, 2014
  Join The Phia Group’s CEO, Adam V. Russo, Esq., as he and Senior Vice President and General Counsel (Ron E. Peck, Esq.), Vice President of Consulting (Jennifer McCormick, Esq.), and a team of expert plan drafting specialists discuss the Phia Document Management system, innovative plan design, and why it is especially relevant in light of changes we predict all plan documents will be required to undergo in the coming years.
• "Dude, Where's My Subro?" - Integrating Subrogation - Sought by Employers & Loved by Administrators
  
  May 15, 2014
  As plan sponsors and administrators examine their benefit plans in light of recent legal upheaval, now is our chance to implement important cost containment mechanisms.
• Taking It To The Limit - Accurately Identifying and Taking Advantage of Network Contractual Boundaries
  
  March 27, 2014
  While it is true that some network contracts restrict a benefit plan’s ability to audit claims – or as is more often the case, simply prohibits the benefit plan from doing anything with the information so identified; some contracts apply unrealistic deadlines and still others contractually compel payment of claims otherwise excluded by the plan document… There are key provisions plan administrators can use to limit or eliminate the negative impact of such provisions.
• To Pay or Not To Pay - Examining Exclusions, Definitions, and Other Things That Really Matter
  
  February 12, 2014
  Whether you are a plan administrator or claims processor trying to determine eligibility of a claim, or a stop-loss carrier trying to determine whether a submission is reimbursable, how applicable provisions apply to specific facts make all the difference.
• A Look Behind, A Look Ahead, Lessons Learned in 2013, and Predictions for the Coming Year
  
  January 8, 2014
  Join The Phia Group as we review the biggest issues dealt with in 2013, the lessons learned, and what we expect to be dealing with in the year to come.
• What You Don't Know Can Hurt You!
  
  November 20, 2013
  As with the Loch Ness Monster and Bigfoot, we have all long believed that Provider Network Agreements exist solely in myth alone, never to be seen by human eyes… until now! From legend to reality; The Phia Group has obtained many provider network agreements, gone through them with a fine tooth comb, and present to you their expert analysis.
• 2014 & Beyond - Reacting to PPACA's Volatile Evolution
  
  September 25, 2013
  Health Insurance Reform (aka Obamacare, aka PPACA, aka Healthcare Reform) has not enjoyed a smooth implementation. In fact, its birth has been quite turbulent. Are you surprised?
• What's Good for the Goose is Good for the Gander? Analyzing BUCA-ASO PPO Agreements!
  
  August 20, 2013
  Join The Phia Group’s CEO – Adam V. Russo, Esq. – as well as its Sr. VP & General Counsel – Ron E. Peck, Esq. – as they dissect contractual terms existing between carriers and their network providers, and share the realization that they know exactly what is important to you.
• Ensuring Cost Containment Success - Member Outreach & Support
  
  July 31, 2013
  On July 31st at 1 PM EST, The Phia Group’s CEO – Attorney Adam V. Russo – and The Phia Group’s Sr. VP and General Counsel – Attorney Ron E. Peck – will address one of the most pressing issues facing our industry today – balance billing.
• Providing For The Future - The Evolution of Plans' Provider Relationships & Exposing Conflicts Between Plans & Providers
  
  May 22, 2013
  For those that are invested in maintaining health benefits, inventing new cost saving methodologies is the “holy grail.” Enter the provider – hospitals, physicians, and other health care facilities.
• Get In Line Before You're Out Of Time - How To Thrive in a Post-PPACA World...
  
  April 25, 2013
  In a world dominated by reform and regulation, there are those who master compliance and thrive, and those who stumble under the burden.
• Getting Employers To Self-Fund In The PPACA Era - Keep Existing Clients Self-Funding... Get New Employers To Self-Fund...
  
  March 13, 2013
  As time passes and elements of PPACA are triggered, the cost of purchasing insurance has become too great. Meanwhile, employers see an opportunity to drop coverage, pay a relatively small penalty, and exile employees to the exchanges.
• Medicare-Plus & Other Cost-Plus Methodologies - The Controversy
  
  February 12, 2013
  The survival of self-funding in the face of PPACA, stricter stop-loss regulation, and the exchanges, is reliant upon doing more for less.
• California / Recovering Benefits from Workers' Compensation
  
  January 23, 2013
  In May of 2012, the California Workers’ Compensation Appeals Board (“WCAB”) adopted amendments, which impact the ability of lien claimants to obtain recovery.
• The State of the Subro-Union Address
  
  January 16, 2013
  The Phia Group’s CEO (Adam V. Russo), Sr. VP and General Counsel (Ron E. Peck), and resident subrogation litigation expert (Christopher Aguiar) will delve into current events, litigation, and changes in law (official and otherwise), as they share the current state of affairs for anyone and everyone interested in subrogation.
• Looking Forward to 2013 - The Phia Group Looks Back at 2012 and Forward to 2013
  
  November 26, 2012
  If you thought 2012 was a wild ride, wait until you see 2013...
• The Bay State Crystal Ball - How Massachusetts May Predict the Future for America's Healthcare
  
  November 14, 2012
  Mitt Romney has been distancing himself from the healthcare reform he signed into law whilst governing Massachusetts. His team has responded to comparisons between “Romneycare” and “Obamacare,” stating that the two laws are vastly different, and vary based on scope of coverage, communities they apply to, and terms themselves. That being said, we can still draw many parallels between the two.
• Trick Or Treat
  
  November 11, 2012
  Plan sponsors are looking for ways to cut costs without limiting benefits. New solutions are popping up everywhere, from medical tourism, to carving out dialysis; from placing a Medicare + cap on allowable expenses, to having outside auditors reprice claims.
• Doing It For Ourselves
  
  November 11, 2012
  June 28th, 2012 is a date that will not live on in infamy or otherwise. On that date The Supreme Court of the United States (“SCOTUS”) took the path of least resistance, declaring that The Patient Protection and Affordable Care Act (“PPACA”) is Constitutional, while tearing the claws from the so-called “mandate’s” enforceability. In one fell swoop, SCOTUS both locked PPACA in as the law of the land, and eliminated the government’s ability to enforce the mandate against individuals.