The Phia Group's Podcast

Tobacco surcharges have long been a common cost containment wellness tool for self-funded plans, but recent lawsuits are putting them under the microscope. In this episode, attorneys Kelly Dempsey and Naga Vivekanandan break down how tobacco surcharges work, why they are treated differently under federal law, and what recent court decisions mean for employers navigating wellness program risk.

In this episode, Phia Group legends – CLO Ron Peck and EVP Jen McCormick – dive deep into waters rarely discussed.  They contemplate how the rising costs of healthcare impact employers and their employees in areas outside of healthcare – from hiring to counting steps.  Join them as they share insight into this, and how to get employees and their families to embrace healthcare literacy, and positively impact aspects of their lives beyond “just healthcare.”

This week on the Empowering Plans podcast, attorneys Corey Crigger and Nick Bonds dig into the growing movement to use psychedelics in treating mental health and substance use disorders. As states ramp up research and regulation, they unpack what’s driving this shift — and what health plans should watch for in a changing compliance landscape.

In the latest installment of The Phia Group’s “Empowering Plans” podcast, attorneys Kendall Jackson and Jon Jablon explore Essential Health Benefits – an important facet of self-funded health plans that seems straightforward, but has garnered a great deal of confusion and misconception through the years. This episode touches on the significance of state benchmark plans, the difference between EHBs and state-mandated benefits, application of EHBs to the maximum out-of-pocket limit, and more.

Join attorneys Bryan Dunton and Cindy Merrell as they discuss what happens when the No Surprises Act collides with subrogation. They explore the practical implications of the legislation, including how it intersects with common recovery models like “pay and chase” and “pend and pay.” This conversation offers valuable insights into how the Act may affect your approach to healthcare claims and reimbursement strategies.

The rules around COVID coverage are entering a new phase. attorneys Kelly Dempsey and Naga Vivekanandan as they explore how recent ACIP guidance narrows preventive coverage for COVID vaccines and what it means for both PPO and HDHP plans. They also dig into the gray areas employers face when updating plan documents and how participants may see their costs shift.

Attorneys Jon Jablon and Nick Bonds break down some of the issues around administering prior authorization requirements, including their use as a cost-containment tool, the procedural aspects, perceptions, and the impact that can have on plan participants. They also discuss some of the regulatory guardrails being put around prior authorizations at the state and federal levels, and some of the key questions for plan sponsors to consider when designing and implementing prior authorization requirements.

Join the dynamic duo of Ron Peck and Corey Crigger as they discuss the surge of equity investment into “sin” services – such as  gambling and adult entertainment – and how this is likely only one part of a bigger strategy… A strategy that ties into the same investors’ recent backing of health care providers treating conditions caused, triggered, or exacerbated by the same behaviors.  Conspiracy theory or incredible insight?  You decide!

In the latest episode of the Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson discuss common misconceptions surrounding RBP plans and the NSA. From protections against balance billing to the Independent Dispute Resolution process, we are covering all of the areas of the NSA that you need to consider for an RBP plan.

On the latest and greatest episode of the Empowering Plans podcast series, attorneys Bryan Dunton and Cindy Merrell discuss news that matters to you: how recent headlines signal sweeping changes to adverse claims determinations and prior authorization practices.