The Phia Group's Podcast

Join The Phia Group's CEO, Adam V. Russo, Sr. VP, Ron E. Peck, and Attorney Brady Bizarro as they discuss the recent, stunning failure of the GOP's American Health Care Act, the most recent news and predictions on the effort to repeal and replace the ACA, and what this all means for the self-funded industry.

Join The Phia Group's CEO, Adam V. Russo, and Sr. VP, Ron E. Peck, as they describe how The Phia Group identifies facilities that provide the best outcomes for the least cost, and encourage plan participants to visit those facilities.

Once again The Phia Group’s CEO, Adam V. Russo, and Sr. VP, Ron E. Peck, delve into what makes their own company’s health benefit plan unique, and share tips employers (and those that service them) can use to improve their own plan’s performance.

In this second installment of The Phia Group's official podcast, our hosts begin sharing what makes their own health plan a source of savings for the employer and benefits employees love.

Welcome to the maiden voyage of "Empowering Plans," a new Podcast by The Phia Group where our hosts will review the purpose of this new series of Podcasts, reveal what the next few episodes will be about, and open the forum to our partners for comments and ideas.

(Music: http://www.bensound.com)

Most situations that involve self-funded benefit plans revolve around language within the plan document. Whether deciding if a service is experimental, or figuring out whether a dependent is actually covered, or deciding whether a leave of absence will extend coverage, the plan document controls in just about all situations. For that reason, it's all the more disastrous when poor plan language handicaps plans and TPAs. Like we always say, your rights are only as good as your language.

The self-funded industry is made up of a complex system of contracts, and navigation across them is anything but simple. Network contracts supersede plan documents; Administrative Services Agreements “add” plan provisions, stop-loss policies embrace carve-outs but networks prohibit them, employee handbooks promise benefits not provided by the SPD…and those are just a few examples of areas of confusion.

Thank you for joining The Phia Group on May 12th, 2016 as its legal team gave a crash course in contracts. Cost-containment can be impacted by the contracts you sign, and there are often exceptions and restrictions buried deep down, or potential issues not considered beforehand. In this webinar, The Phia Group explained some of the contracting pitfalls experienced on a daily basis within the self-funded industry.

The self-funded industry changes rapidly and without notice. In recent memory, the biggest culprit has been the ACA - and in its aftermath, there have been numerous regulatory guidelines and court cases that have helped interpret the ACA's provisions. Still, though, there are many other changes occurring at any given time. Examples include assignments of benefits, discrimination, preemption, bankruptcy, subrogation, stop-loss, and more.

Thank you for joining The Phia Group's legal team as they described recent goings-on within the legal and regulatory framework in which we all operate. Being aware of changes within the industry can be important to take the necessary action as well as to be able to predict and prepare for what might be on the horizon.

Through our consulting inquiry referral channel ([email protected]), The Phia Group receives hundreds of consulting questions every month. It is apparent that TPAs, brokers, employers, and the health plans they sponsor are under a great deal of stress to comply with various legal and contractual obligations, identify the reasons for rising costs, and implement services meant to differentiate themselves while preserving the industry as a whole. The Phia Group has been here to help every step of the way, with advice, services, and plan drafting techniques enabling plans to execute almost any program.

Identifying where problems exist is a chore in and of itself; our goal has always been to help you identify and fix your pain points, and prevent them in the future. Thank you for joining our legal team in this latest installment of The Phia Group’s webinar series, where we discussed a potpourri of various repeat issues we see on a daily basis, and best practices for how to resolve them, to help make sure you’re as compliant and efficient as possible.

As the self-funded industry evolves, benefit plans are forced to evolve with it or get left in the dust. Employees need quality coverage – but providing robust yet affordable programs has proven difficult for many self-funders. This conundrum can be addressed by changing inefficient or archaic processes; in response to contractual handcuffs limiting your ability to target cost drivers, too many health plans and TPAs overreact, thinking that the solution is to trash their plan entirely, and to try something new and untested – trading security for savings.

When it comes to benefits, don’t remove, don’t reduce… replace! Avoid the extreme sides of the spectrum, achieve balance, and ensure your own viability with “The Replacements.” Thank you for joining The Phia Group on Tuesday, February 16th as we identified the trouble spots found in all benefit plans, provided ideas for how to carve them out, and replace faulty portions with new alternatives – without harming the rest of the plan!