The Phia Group's Podcast

In this edition of the Empowering Plans podcast, Brian O’Hara and Alex Houle of The Phia Group’s Provider Relations department discuss advancements in Artificial Intelligence, how it is being utilized in healthcare, and the ways providers and health plans are using AI to manage NSA dispute resolution. 

In this episode, Garrick Hunt and attorney Kelly Dempsey discuss AI entering the self-funding playing field. From claims administration to the liabilities that may fall on plans and their TPAs, there’s so much to discuss and unfortunately a lot of unknowns. Take a listen and share your thoughts and feedback, which might allow Garrick to make another guest appearance on a Part 2 episode on AI and self-funding.  

In this episode of the Empowering Plans podcast, we examine real-world claims that spiraled into appeals, IDR proceedings, provider disputes, participant complaints, and potential litigation in order to demonstrate that a plan can make all the right decisions but still end up in the wrong place. Attorneys Jon Jablon and John Gresh discuss why strong plan language and a defensible rationale are only part of the equation, and why clear communications, careful documentation, timely administration, and early identification of potential problems have become more important than ever.

Tune in for an update from The Phia Group’s CLO, Ron Peck. He’ll bring you up to speed on Phia’s efforts to tackle the hottest topics each month, while also exploring how third-party liability may be contributing to denial and appeal headaches. All while, of course, harassing our podcast producer. Tune in and tune up with Professor Peck!

What separates a denial that withstands judicial scrutiny from one that does not? In this episode, Cindy Merrell explores the key considerations courts may evaluate when reviewing challenged denials. From investigating the facts to clearly articulating the basis for a decision, this episode identifies practical steps that can help administrators improve outcomes and mitigate litigation exposure. 

What happens when a benefits denial doesn't tell the whole story? Attorneys Cindy Merrell and Bryan Dunton examine E.O. v. Premera Blue Cross, a case that underscores the risks of incomplete claim evaluations and poorly communicated denial decisions. They break down the court's reasoning and discuss what plan administrators can do to reduce litigation risk and improve decision-making. 

In this week's episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O'Hara break down the Third Circuit's recent decision in Ahn v. Cigna and what it means for ERISA preemption and explanation of benefits (EOB) language.

On this episode of the Empowering Plans podcast series, Attorneys Kelly Dempsey and Naga Vivekanandan discuss recent 340B litigation filed by three major hospital systems. They explain how the 340B program works and summarize the allegations in the lawsuit, as well as explore what these cases could mean for contract pharmacy arrangements and self-funded plans. 

On this episode of the Empowering Plans podcast series, attorneys Jen McCormick and Nick Bonds talk through some of the pressures self-funded plans face from every direction -- rising member costs, PBM opacity, shifting coverage models, and instability in the individual market. The plans that respond well are those with clear governance and the ability to keep track of who decides, who communicates, who monitors, and who holds the risk. Containing costs requires a well-run plan; a well-run plan requires good governance. 

On this week's Empowering Plans Podcast, attorneys Ron Peck and Nick Bonds discuss the growing popularity of alternative healthcare arrangements. What's driving interest in these alternatives? What financial pressures are fueling their growth? Can they deliver on their promise? In a landscape of ever-increasing healthcare costs, these arrangements often offer a more affordable alternative to traditional coverage, but in exchange plans and participants can be left holding more risk than they realize. Be informed before you roll the dice! The Phia Group is here to help.