Recent Posts

  • Black Lives Matter … Yes, Even in Healthcare
    July 8, 2020
    By: Philip Qualo, J.D. Just when the United States was starting to adjust to a new COVID-19 reality, where bejeweled face masks, social distancing and hand sanitizer have become as fundamental to our existence as water, current events have yet again set us down a new trajectory in these unprecedented times. The May 25th murder of George Floyd, a Black man who was unarmed and handcuffed at the time of his death at the hands of law enforcement sparked a series of national protests that has called on the world to reexamine policies and practices that disproportionately impact people of color. The protests have spawned into a national movement in the U.S. that has aimed at reforms in law enforcement practices and legislative accountability. There is a very important arena, however, where racial disparities are not being discussed at this time, and that is in healthcare.  Disparate access to affordable, yet effective, healthcare has and continues to have disproportionately negative impact on people of color. In most cases, access to healthcare can be the difference between life and death. ...
  • Old Issues, New Environment – Not The Same Old Song
    June 16, 2020
    Join The Phia Group’s team of experts as they discuss familiar issues such as balance billing, surprise billing, mental health parity, telemedicine, COB, and others, while framed in the context of these unique times. How has COVID-19 changed these issues, if at all? How is the new employer environment exposing these issues? Listen in to find out what The Phia Group has to say! Click Here to View Our Full Webinar on YouTube Click Here to Download Webinar Slides Only
  • No Contract? No Problem!
    June 15, 2020
    By: Jon Jablon, Esq. In this strange time (strange because of both COVID-19 and the state of self-funded in general), things move at – to quote our CFO/CIO Joe Montalto – “the speed of business.” Candidly, I have never really been sure what that means, despite my smiling and nodding when he says it, but I think it’s a euphemism for “fast.” Things move fast. And you can quote me! How that manifests in our industry, in Phia’s experience, is that sometimes, a client needs certain services performed ASAP. There may not be time to receive an agreement, review it, collaborate with peers, make changes, have those approved by the vendor, and run a final version by upper management prior to the performance of the services. Certain vendors such as stop-loss carriers are extremely unlikely to proceed without written agreements either due to applicable law or liability concerns, but many vendors will happily begin performing services on no notice when their clients really need it. It can certainly be potentially dangerous, since contracts are, after all, designed to protect the parties ...
  • Privacy Pitfalls - Considerations for Reopening the Office
    June 10, 2020
    By: Nick Bonds, Esq.   Summer is officially here, and employers and employees alike are all wondering if, when, and how to go back to the office. After a spring spent cooped up at home self-isolating and social distancing, many are eager to get back into their old routine, to reclaim some sense of normalcy. While we can all certainly sympathize with that sentiment, the specter of the coronavirus still looms large. To safeguard our collective health and sanity, we all have a responsibility to ensure that a return to office life is handled carefully, lest we experience a resurgence in cases and find ourselves cloistered in makeshift home offices for many months more.   The ideal solution is a vaccine, but that goal will likely not be realized until sometime in early 2021. Once a vaccine is created, there may still be delays in producing and distributing doses to Americans and the rest of the world, further delaying a return to something resembling the before times. To return to our workplaces sooner, the search continues for more immediate solutions.   Many employers, ...
  • IRS Temporarily Expands Cafeteria Plan Midyear Election Changes in Response to COVID-19
    June 3, 2020
    By: Philip Qualo, J.D. The Nation’s response to the COVID-19 pandemic called on employers to exercise greater flexibility and understanding for employees impacted by COVID-19. For the most part, the series of legislations enacted since the pandemic hit the U.S. have been aimed at expanding unemployment, group health plan coverage, leaves of absence, and providing financial support to struggling employers and Americans faced with an economy that evaporated overnight. However, plan sponsors offering benefits on a pre-tax basis through Internal Revenue Services (IRS) Section 125 cafeteria plans struggled to correlate the nationwide call to provide flexible options employees with the strict terms of their cafeteria plans. Section 125 cafeteria plans are required to maintain employee pre-tax elections for benefits offered through the plan for the full plan year, with very few exceptions. The type of benefits offered through a cafeteria plan generally include employer-sponsored health coverage, Health Flexible Spending Arrangements (Health FSAs) and Dependent Care Assistance Programs (DCAPs). The IRS also imposes strict limitations on when midyear changes to those elections may be made. As employers have been forced to deal with ...
  • Hospitals Face Unprecedented Losses Due to the COVID-19 Pandemic
    June 1, 2020
    By: Andrew Silverio, Esq. As the days in isolation continue to stretch into weeks and eventually months, it seems there is no industry or business that has not been impacted by the COVID-19 pandemic.  But a recent report released by the American Hospital Association (available at https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due) reveals a significant financial impact on hospitals and health systems, entities which are truly on the front lines of the fight against COVID-19.  This may seem counterintuitive – one might expect that a massive public health event like a viral pandemic would result in an influx of business and corresponding increase in revenues for hospitals and other providers.  However, the report outlines various ways in which these providers are suffering significant losses – estimated at $202.6 billion over four months, or $50.7 billion per month. First, many Americans sheltering in place and reluctant to risk exposure to the virus are canceling or postponing standard care, and shortages of protective equipment and crucial drugs have forced providers to incur increased cost to secure these materials.  Additionally, the sudden and historic surge of unemployment ...
  • Empowering Plans: P84 - Workers' Comp. & COVID-19 - Preparing for an Influx
    June 1, 2020
    In this episode, Brady Bizarro and Jennifer McCormick discuss the impact of COVID-19 on workers' compensation claims. How can we tell if employees were exposed at work? How should employers prepare for an influx in claims? What actions are state legislatures taking across the country to expand workers' compensation benefits for pandemic-related injuries? Our legal experts grapple with these questions and more. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • A Pandemic Economy – Industry Risks and Opportunities
    May 19, 2020
    As the economy suffers, our industry is impacted when employers furlough employees or implement layoffs, as well when employers can no longer afford to offer benefits or continue operations.  Fewer benefit plans, fewer plan participants, and dramatic changes in claim type and volume are certain, leaving health benefits at risk during a time when they are most needed.  Yet, there are those that are improving coverage, leveraging opportunities, and preparing to take advantage of the employer, employee, and claims growth likely to follow a lifting of stay-at-home orders.  Join The Phia Group as they discuss ways administrators are extending benefits and taking care of those in need.  From COBRA to workers' compensation, mandates to stop-loss, join us to discover innovative ways to conquer the challenges and come out on top. Click Here to View Our Full Webinar on YouTube Click Here to Download Webinar Slides Only
  • DPC During a Crisis
    May 13, 2020
    By: Jon Jablon, Esq. In case you haven’t heard, COVID-19 is kind of a bummer. We’re all at home, and like my colleague Jen McCormick, I’ve got a toddler who wants nothing more at any given time than to go to a playground. Even after so many weeks of this, it still seems surreal to be able to say “sorry, buddy, but if we go to a playground, dad might go to jail!” Anyway. This blog post is about direct primary care! Some have expressed the view that the best feature of DPC is the personalization of care; others say the best thing about it is the flat fee. In my view, though – through COVID-19-colored lenses – the best thing about DPC is that direct primary care providers are already prepared to work from home. When I text Dr. Tremblay, it doesn’t matter that his office is closed. It doesn’t matter that I could go to jail if I bring my son to a playground. No – all that matters is that during this crisis, my DPC provider is available to ...
  • WC Recovery in a Post COVID World!
    May 6, 2020
    By: Chris Aguiar, Esq. There are so many fascinating things to debate in what can only be described as perhaps the strangest times we as a society have collectively endured. Should we open the economy at the expense of American lives? Does the data even support this notion that social distancing makes a difference? How could the models have been so far off their original projections? How did the current administration do with respect to its response? It would be disingenuous to say that these are not topics in which I am interested, but in terms of the day to day business of a subrogation professional (and in the context of this blog), I’m thinking much more in the weeds. The immediate question a lot of our subrogation clients are asking is quite simply, what is the rule regarding workers' compensation claims with respect to this pandemic? Will medical professionals, first responders, and even essential employees be able to make claims for workers' comp? One’s gut reaction might be to say, “of course they can!” – But deeper analysis ...
  • Bouncing Through Quarantine
    May 4, 2020
    By: Nick Bonds, Esq.   While some of the United States is tentatively beginning to reopen, much of the country remains firmly under social distancing orders. The ripple effects of keeping people cooped up with their families vary wildly, but many are reveling in the extra time spent together, and are finding numerous ways to stay sane and entertained in the face of the Covid-19 pandemic.   Some of this has led to fairly predictable shortages, but there are reasons for hope. Aside from the struggle of grocery stores (and even a few global online retail-giants-who-shall-not-be-named) to keep toilet paper, disinfectant wipes, and hand sanitizer in stock, the fact that our stores’ shelves have been rendered entirely barren should be seen as a testament to the resilience of our modern supply chain.   Nonetheless, there are a number of things you just can’t find right now. Toilet paper remains scarcer than I’d like it to. The meat case at my local store has been pretty sparse of late. You probably can’t buy a Nintendo Switch from a traditional retail outlet at MSRP ...
  • Did HHS Just Ban All Surprise Billing During The COVID-19 Pandemic?
    April 29, 2020
    Andrew Silverio, Esq. Apologies for the attention-grabbing headline, but no, as good as that would be for payers, it didn’t.  However, Kaiser Health News recently ran a story, which was also picked up by NPR, speculating that this is precisely what had occurred. The article, which ran on April 17, 2020, discussed the terms and conditions placed on providers who receive funds from the Public Health and Social Services Emergency Relief Fund under Public Law 116-136, one of which states that “… for all care for a presumptive or actual case of COVID-19, Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient.” For its expansive reading of this seemingly limited prohibition on balance-billing, KHN points to a statement on an explanatory HHS website (the article links to https://www.hhs.gov/provider-relief/index.html) stating that “HHS broadly views every patient as a possible case of COVID-19.”  The rationale then, is that if providers can’t ...
  • Empowering Plans: P83 – Video Conferencing & the Risk to PHI
    April 27, 2020
    In this episode, Ron Peck and Brady Bizarro are joined by consulting attorney Nicholas Bonds. Nick describes the unique concerns facing covered entities and their business associates as more of us utilize video conferencing platforms while under quarantine. What steps should you take to keep PHI safe? Finally, Ron and Brady end on a high note, summarizing some of the positive COVID-19 news that has come of late. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • The Silent Impact of COVID-19: The Rise in Mental Health & Substance Abuse Disorders
    April 27, 2020
    By: Philip Qualo, J.D. Before COVID-19 became a common household name, the United States was already in the midst of a mental health crisis. Rates of suicides and drug overdoses have been climbing in recent years; for example, in 2017, 17.3 million adults in the U.S. had at least one major depressive episode. This staggering figure is likely not even a true reflection, as studies show many people don’t seek treatment at all finding that stigma and shame keep 80% of people out of treatment. As the COVID-19 pandemic has consumed the nation, and the world, many of us are learning the hard way that life during a pandemic has even the most resilient of us drowning in unprecedented levels of stress. School and work closures, as well as stay-at-home orders, feel like they might stretch on for months. The volatile economy and sudden job losses have added a layer of financial insecurity that wasn’t a factor in people’s lives just a few weeks ago. Meanwhile, the rates of COVID-19 infections are rising exponentially, creating intense anxiety about what day-to-day ...
  • Reasons for Optimism
    April 23, 2020
    Together we are all enduring common trials.  It is certainly one of the most difficult periods in our history – as an industry and as Americans; and yet, opportunities exist.  Both presently, and heading down the pike, there are reasons for optimism.  Join The Phia Group as they discuss the many GOOD and POSITIVE things that have both improved our industry since the end of 2019, and that are on the way.  We will discuss opportunities that exist now, that are forthcoming, and why we foresee YOU flourishing post-COVID-19. Click Here to View Our Full Webinar on YouTube Click Here to Download Webinar Slides Only
  • COVID-19: Social Distancing and Paid Sick Leave
    April 14, 2020
    By: Kevin Brady, Esq. The national shift to social distancing has effectively changed the way almost all of us go to work. For some, rather than physically report to an office, we simply wake up (hopefully followed by some coffee), and get the day going. The daily “Good Morning” from a coworker is sent over skype, the “Boomers” are now masterful “Zoomers”, and many talented folks juggle the full-time job of parenting while somehow managing their full-time work responsibilities each day. For some (very brave) others, such as nurses and grocery store employees, the way they report to work may not have necessarily changed, but the workplace they go to has taken on an entirely new light. While it has been a significant shift, those who are able to work remotely are certainly lucky to have the opportunity to do so. Shelter-in-place orders, albeit an absolutely necessary measure to flatten the curve of COVID-19, have had a significant impact on how people work and has unfortunately resulted in a lack of “work” for many. In an effort to protect employees during ...
  • Empowering Plans: P82 – COVID-19: Studies on Treatment Costs & Industry Impact
    April 13, 2020
    Join Attorneys Brady Bizarro and Jennifer McCormick as they discuss some of the latest studies on the potential cost of COVID-19 treatment for self-funded plans, the projected impact on employer-sponsored insurance, and how they think this pandemic could change the industry. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • COVID-19… And What it Means to Work From Home with Small Children
    April 13, 2020
    By: Jen McCormick, Esq. COVID-19 has impacted most aspects of our lives, and the lives of our families.  From a healthcare perspective, we want to do all we can to protect our families from the virus.  In most cases this means that households where both parents work outside the home and children attend school or daycare are now all confined to their homes… every day. We do this in hopes of keeping the children and ourselves safe.  Being confined to our homes, however, can be challenging in many ways. For families where being home is the exception over the rule this has been an adjustment.  We are forced to redefine our roles as co-workers, parents, and spouses to find the perfect work-home balance, all while at home.  Dealing with this new normal is hard, and certainly pays a toll on our mental health. Mindful of this extra stress for many, plans and employers should consider additional ways to help. Consider ways the parent can use their health plan, for example, does the employer health plan cover telehealth? Is this available for ...
  • COVID-19 Testing & Cost-Containment
    April 1, 2020
    By: Jon Jablon, Esq. The CARES Act is brand new, obviously, but its treatment of the relationship between medical providers and health plans is anything but. As with just about all legislation to date on the topic of payor-provider relations, the legislature has not hesitated to essentially give all the power to the providers. The bill includes the following provisions: SEC. 3202. PRICING OF DIAGNOSTIC TESTING. (a) Reimbursement Rates.—A group health plan or a health insurance issuer providing coverage of items and services described in section 6001(a) of division F of the Families First Coronavirus Response Act (Public Law 116–127) with respect to an enrollee shall reimburse the provider of the diagnostic testing as follows: (1) If the health plan or issuer has a negotiated rate with such provider in effect before the public health emergency declared under section 319 of the Public Health Service Act (42 U.S.C. 247d), such negotiated rate shall apply throughout the period of such declaration. (2) If the health plan or issuer does not have a negotiated rate with such provider, such plan or issuer shall reimburse the provider ...
  • Empowering Plans: P81 – COVID-19: Provider & State Impact
    March 31, 2020
    In this public health emergency, the federal government is not the only entity taking significant action. Join attorneys Brady Bizarro and Kelly Dempsey as they dive into the unique responses we have seen from individual states and providers while evaluating their impact on the self-funded industry. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • COVID-19: The CARES Act & Workplace Safety FAQs
    March 31, 2020
    In the fight against COVID-19, events are unfolding at a breakneck pace. Congress just passed the largest recovery bill in American history. Employers are facing serious questions about their obligations and liability during this crisis. Join The Phia Group for this special edition webinar as we discuss the impact of this historic federal legislation on our industry and answer your questions about workplace safety. Click Here to View Our Full Webinar on YouTube Click Here to Download Webinar Slides Only
  • Special Edition - The Phia Group and COVID-19 FAQs Answered
    March 23, 2020
    From inquiries about how to comply with regulations to revising plan documents, The Phia Group has received many questions from brokers, employers, TPAs, and stop-loss carriers about COVID-19. As always, The Phia Group is ready to assist. ICE clients are able to continue accessing unlimited aid, while all others should send questions to PGCReferral@PhiaGroup.com without delay. Additionally, to further aid our clients and the industry we serve, The Phia Group will be hosting a special webinar, addressing the COVID-19 pandemic and the industry's most frequently asked questions. Click Here to View Our Full Webinar on YouTube Click Here to Download Webinar Slides Only
  • Waiving Copays and Deductibles for Testing Isn’t Enough – The Impact of COVID-19 on the Patient’s Pocket
    March 20, 2020
    By: Kevin Brady, Esq. In response to the mounting need to flatten the curve and slow the spread of COVID-19, the federal government has taken overt action in the passing of the Families First Coronavirus Response Act. The act effectively removes the financial barriers and facilitates access to testing, by requiring group health plans of all shapes and sizes to waive cost-sharing for expenses related to COVID-19 testing. The federal mandate to waive all cost-sharing on testing is significant, but may not be enough to address the potential costs that patients may ultimately bear. The testing was free, but those who test positive now need care; and that care may be significantly costlier than one may think. According to a brief prepared by the Kaiser Family Foundation (KFF), even those patients with health insurance could face significant financial pressure following the treatment of COVID-19. For purposes of the study, KFF did a deep dive on the potential costs of treatment for COVID-19 by researching data on the treatment of pneumonia, and the out-of-pocket costs that individuals with health coverage may expect. For those ...
  • Empowering Plans: P80 – COVID-19: Latest Updates & Legislation
    March 19, 2020
    In this episode of Empowering Plans, Ron Peck and Brady Bizarro discuss the latest developments related to COVID-19, the impact on the self-funded industry, and review the contours of the Families First Coronavirus Response Act, which guarantees free coronavirus testing for all Americans as well as an expansion of paid sick days for a subset of workers. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Empowering Plans: P79 - COVID-19 Preparedness: What Self-Funded Plans Should Be Doing Right Now
    March 11, 2020
    In this special edition of Empowering Plans, Brady Bizarro and Jennifer McCormick discuss the recent outbreak of COVID-19 (coronavirus). Join them for their insight into how you should be preparing, what concerns you should have about your benefits documents, and how to navigate applicable law. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)