The Phia Group Blog

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…

By: David Ostrowsky As employers across a wide swath of industries gravitate towards adopting self-funded health plans, the demand for stop-loss protection has naturally mushroomed. After all, an employer going down the self-funded road that passes on stop-loss is taking…

By: David Ostrowsky Over one million Americans live with H.I.V. and  nearly 25 percent of them rely on the Ryan White AIDS Drug Assistance Programs, otherwise known as ADAPs, to manage their conditions. These federally-funded assistance programs are a life-saver…

By: Bryan M. Dunton, Esq. Prescription drug costs remain one of the most visible challenges for employer-sponsored health plans and the employees who rely on them. Over the past several years, policymakers have increasingly focused on pharmacy benefit managers (PBMs),…