Phia Group

Empowering Plans: P184 – State of the Union, 2024

On March 8, 2024
In his third State of the Union address, President Biden touted his administration’s record and outlined the issues he and his team will likely be campaigning on heavily as the 2024 presidential race kicks off in earnest. Sprinkled throughout were a number of policy wish list items, including some key healthcare initiatives that we’ll be keeping a close eye on in the coming months. Attorneys Brady Bizarro and Nick Bonds bring you some of the highlights in this episode of the Empowering Plans podcast.

How the Recent Industry Cyberattack Impacts You

On March 7, 2024
Late last month, an apparent massive cybersecurity incident involving the potential theft of patient data – this could entail personally identifiable information, sensitive health information, and financial information -- and encrypted company files seemingly paralyzed one of the nation’s largest pipelines for healthcare payments and prior authorization processing. Impacting a substantial percent of Americans’ medical claims (billions of claims totaling over a trillion dollars per year), millions have been affected. But perhaps the worst part is that many don’t even know it – and won’t be aware until they need to visit their physician or refill a prescription and face new hurdles in getting their customary treatment.

Empowering Plans: P183 – The Therapeutic Equivalence Approach: A New “Pill”ar of Contraceptive Coverage

On February 29, 2024
The DOL recently issued new guidance on the long-standing contraceptive coverage mandate, and this time they took a different approach. Instead of clarifying prior guidance or issuing novel interpretations of the law, the DOL is giving health plans an alternative way to comply with the contraceptive coverage mandate: either follow the prior guidance issued in 2022… or don’t! The DOL introduced the “therapeutic equivalence” approach, whereby plans can comply with the law in a different, potentially less-burdensome way. Join The Phia Group’s Kendall Jackson and Jon Jablon as they discuss this “therapeutic equivalence” approach to compliance, what it means for consumers, and what it means for health plans.

Millions Saying Good-Bye to Medicaid

On February 22, 2024
That millions of Americans have been losing Medicaid coverage over the past year may be unsurprising, but it doesn’t make it any less heartbreaking.

The Skinny on Weight Loss Drugs

On February 21, 2024
From Contrave to Saxenda to Wegovy and beyond, society is being bombarded with messaging about weight loss drugs. While many publicly debate their efficacy and long term viability, far fewer are openly asking who will pay for them – and how. For those of us that sponsor and service health benefit plans, the costs arising from this trend are very real. While we want to help people lose weight, get fit, and improve their overall health – the best way to approach this matter is still uncertain. Join The Phia Group for another free webinar! Our team will discuss this very relevant topic, including related issues such as off-label drug usage, international drug importation, defining medical necessity, plan drafting and exclusions. Likewise, the importance of educating plan membership about the costs of healthcare, and what it means to be self-funded.

Empowering Plans: P182 – Navigating Post-Settlement Fund Pursuits

On February 15, 2024
Attorneys Andrew Silverio and Cindy Merrell discuss a newly decided case which provides a roadmap for pursuing settlement funds after disbursement. Who has the burden of proof when the funds have been dissipated? What is lowest intermediate balance rule?

Welcome to the Subrogation Sphere

On February 9, 2024
Las Vegas does not have the only sphere that can provide an extraordinary experience for its participants. Let me introduce you to the subrogation sphere where participants may first appear to have conflicting interests but can become allies. When a health plan member is injured because of a third-party action it sets into motion a dance involving many players, potentially including the plan participant, at-fault party, medical providers, stop loss carrier, and the health plan. Each player is trying to determine which player is the proper payor of the plan participant’s medical expenses.

Empowering Plans: P181 – Chevron Deference in Peril – What It Could Mean for Healthcare Regulations

On February 1, 2024
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O’Hara discuss the legal doctrine involved in two cases now before the Supreme Court – Chevron deference. They’ll explain what it means, why it is important for federal agency action, and how it impacts the entire healthcare industry. With a decision expected by this summer, you do not want to miss our take on how the NSA, the Medicare drug price negotiations, and the ACA itself could be at stake.

Are Measles Making a Comeback?

On January 31, 2024
The ever-serious epidemiologist out of Minnesota, who forewarned of a global pandemic years ago and has garnered the not-so-flattering nickname “Bad News Mike,” has a new dire message about the recent measles outbreak, one to which children are most susceptible, that has started to trickle through pockets of Europe and, more recently, the US:

Empowering Plans: P180 – The Continuing Evolution of MHPAEA

On January 18, 2024
One might think they’re listening to a broken record when hearing Jennifer McCormick and Kelly Dempsey discuss the ever-shifting landscape of the Mental Health Parity and Addiction Equity Act (MHPAEA), but alas, this is a brand new podcast! As we start 2024, we are reframing our mindset and are making some changes to address the evolving MHPAEA regulations and insights we have received from regulating bodies through the NQTL Comparative Analysis Process. In addition to highlighting the significance of how these issues should be addressed within an employer’s PD/SPD, there are three main changes discussed to create visibility for employers creating new 2024 PD/SPDs.

A New Year Brings New (Higher) Prescription Drug Prices

On January 18, 2024
It must be January. W-2 forms are hitting the mail. Fitness centers are packed to the brim. The NFL playoffs are in full force.

Considerations Regarding the Exclusion of Gender-Affirming Care

On January 16, 2024
Gender-affirming care was a particularly popular topic throughout 2023. As we enter the new year, the prevalent discussion concerning plan coverage of such care will certainly continue.

Navigating 2024: The Latest, Most Innovative Plan Design Features & Stop-Loss Policy Updates

On January 16, 2024
In this first webinar of 2024, our crew will provide a rundown of 2024’s biggest plan document and stop-loss updates, including matters about which our team has been asked the most. Stay ahead of the crowd, and join The Phia Group as we jump into the year with a head start. Together we will resolve lingering problems of the past and equip you with a list of changes to expect and topics you need to monitor in 2024 and beyond.

The Phia Group's 1st Quarter 2024 Newsletter

On January 11, 2024
The Phia Group is off to a great start in the first quarter of 2024! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

Empowering Plans: P179 – Higher Healthcare Prices (Made From Concentrate)

On January 4, 2024
The trend of provider consolidation is primed to pick up pace in 2024, distilling some areas into even more highly concentrated healthcare markets. Ron Peck and Nick Bonds break down how this concentration impacts the costs of healthcare and can drive costs upward for employers and employees alike. With fewer provider options, higher prices, and patients caught in the middle, Ron and Nick outline just a few of their concerns and discuss some of the tools health plans have at their disposal.