The Phia Group Blog

By: Jon Jablon At its core, stop-loss has a nice, simple job: to provide financial protection for a health plan, via the employer, when the plan incurs covered catastrophic claims. That’s still the case, but the No Surprises Act (NSA)…

By: Kate MacDonald These days, plan administrators may feel like the self-funded landscape is akin to the wild, wild west. Many plan administrators wear many hats: They’re often both business owners and are responsible for insuring their employees and their…

By: Bryan M. Dunton, Esq. The No Surprises Act (NSA) was enacted to address a specific and highly visible problem: patients receiving unexpected out-of-network bills for care they did not choose and often could not avoid. In that respect, the…

By: David Ostrowsky Providers may be getting reimbursed from insurers in a timely manner, but improved cash flow hasn’t correlated with bountiful payments. And the chief culprit, unsurprisingly, appears to be an increase in clinical denial rates, largely stemming from…

By: Kendall Jackson, Esq. It’s no secret that PBM reform has been a priority in the self-funded industry for many years now. Countless bills, both on the state and federal level, have been introduced to rein in the broad expanse…

By: Nick Bonds, Esq Artificial intelligence is rapidly transforming the healthcare landscape—touching everything from how drugs are developed to how care is delivered and how claims are processed. For self-funded plans and their partners, AI presents meaningful opportunities to improve…