The Phia Group Blog Posts

Navigating Balance Billing and Post-Payment Disputes: Solutions for TPAs and Self-Funded Employers

On November 14, 2024
As rising healthcare costs continue to challenge employers and third-party administrators (TPAs), Reference-Based Pricing (RBP) has emerged as a powerful strategy for cost containment. However, RBP, while promising, is not without its pitfalls. Chief among them is balance billing, in which providers charge patients for the difference between their billed charges and the RBP plan’s payment. Additionally, the No Surprises Act (NSA) has introduced Open Negotiations and Independent Dispute Resolution (IDR) processes, which, while protecting patients, expose employers to post-payment disputes. Addressing these concerns effectively requires comprehensive tools, support, and strategic implementation.

Having NSA Problems? Better Call The Phia Group

On October 31, 2024
The Independent Dispute Resolution (“IDR”) process was designed to be a cornerstone of the No Surprises Act (“NSA”), a means for resolving claims for payment for out-of-network items and services and a vital mechanism for buttressing the NSA’s protection for plan members against potentially devastating balance billing expenses. Unfortunately, since the NSA took effect on January 1, 2022, things have gone awry on many fronts.

Empowering Plans: P204 – Nightmares on Self-Funded Street

On October 24, 2024
Join Attorneys Corey Crigger and Kendall Jackson on this Halloween edition of the Empowering Plans Podcast. Corey and Kendall take a look at topics that send shivers down the spine of the self-funded industry. How do you protect your plan from the scary cost of gene therapies? What will the rapidly advancing AI sector mean for you and your clients? What is the best trick or treat candy? Tune in to find the answers to these questions and many more on the Empowering Plans Podcast.

Industry Crossroads – How the 2024 Election Impacts You & Major Implications For Our Industry

On October 17, 2024
Although healthcare hasn’t stolen the limelight as it did in past elections, those “in the know” know that the results of this historic election will have a major impact on healthcare and health benefit plans alike. Between soaring drug costs, increased fiduciary litigation, the impact of A/I, and growing popularity of weight-loss drugs (which is likely to escalate as the year ends), to thrive in 2025 and beyond industry insiders must understand the current state of the market as well as predict what is to come. Join us as we discuss these and other pressing issues. Also, speaking of A/I, our team will present a live demonstration of SoPhia, our very own chatbot, which will engage with audience questions.

Cobenfy: A Potential Game-Changer for Schizophrenia Patients – But at What Price?

On October 9, 2024
As you’re reading this blog, millions worldwide are suffering from the horrors of schizophrenia, one of the most complex, debilitating, and stigmatized mental disorders inflicted on humanity, the symptoms of which typically manifest themselves in early adulthood, though they are not always so easy to detect. Those afflicted by this condition are desperately trying to manage an array of frightening symptoms (hearing voices, delusions, memory lapses to name a few) while carrying on with their lives. In this country alone there are approximately 2.8 million Americans living with schizophrenia; tragically, many of those 2.8 million Americans won’t be living much longer as there is a particularly acute rate of suicide among people battling schizophrenia. Meanwhile, so many others suffering often experience prolonged bouts of homelessness and/or run afoul of the law. And for decades, pharmacological innovation has moved at such a glacial pace that treatment has largely yielded inadequate improvement in symptoms and/or intolerable side effects during therapy that many have felt inclined to discontinue usage.

Healthcare and Politics… Ugh. Old News!

On September 27, 2024
Donald Trump recently stated that while he will never give up on repealing the ACA, he also said that he was not running on terminating the ACA. This is likely a smart decision, given that a recent Kaiser Family Foundation (KFF) poll revealed that for Republican voters, repealing Obamacare was an important issue for a very small percent of respondents. Is this demonstrative of a more widespread loss of interest in health care as a political talking point?

The Phia Group Announces the Hiring of Justin Forton as a Client Success Account Executive

On September 19, 2024
CANTON, MA – September 19, 2024 – In its continued dedication to bolstering the health benefits industry, The Phia Group has hired Justin Forton as a Client Success Account Executive. Justin will channel his data analytics experience and industry-focused customer service expertise to support and collaborate with The Phia Group’s clientele.

The First Ten: Medicare Unveils Inaugural List of Negotiated Drug Prices

On September 16, 2024
Last month, while many of us were busy vacationing or doing last-minute back-to-school shopping, the Biden administration announced that it had reached an agreement with the titans of the pharma industry to lower prices on the 10 costliest prescription drugs under Medicare, thus bringing to fruition Democrats' decades-long push to allow the government to negotiate directly with pharmaceutical manufacturers. While individual plans had previously been able to haggle over prices with Big Pharma, this development marks a seminal moment as it is the first time that Medicare used its clout to be able to negotiate for the program as a whole.

Empowering Plans: P201 – Diving Into the Parity Pool: MHPAEA’s Latest Updates

On September 12, 2024
Regulators finally announced the long-awaited MHPAEA Final Rules on September 9, 2024. Many of these changes will directly affect group health plan design and modify the NQTL comparative analysis testing requirements - many of which will be significant for plans as they prepare for 2025. Join attorneys Jennifer McCormick and Bryan Dunton for their discussion on several critical considerations for plans as renewal season approaches.

The Phia Group Announces Enhancement to Ecosystem of Services: Care Empowered Pricing

On September 11, 2024
The Phia Group’s industry-leading ecosystem of cost containment services, including ICE, Subrogation & Recovery, PACE, and Phia Unwrapped, has been bolstered with Care Empowered Pricing, a cutting-edge Reference-Based Pricing (RBP) model providing quality care and fair pricing tailored to your needs.

Phia Group

Phia Group Media

Navigating Balance Billing and Post-Payment Disputes: Solutions for TPAs and Self-Funded Employers

Empowering Plans: P205 – Lessons From a Florida IDR Case

Having NSA Problems? Better Call The Phia Group

The Future of Birth Control in America

Empowering Plans: P204 – Nightmares on Self-Funded Street

Industry Crossroads – How the 2024 Election Impacts You & Major Implications For Our Industry

The Phia Group's 4th Quarter 2024 Newsletter

Empowering Plans: P203 – Gender-Affirming Care, Is it Covered?