The Phia Group, LLC is an experienced provider of health care cost containment techniques offering comprehensive consulting services, legal expertise, plan document drafting, subrogation and overpayment recovery, claim negotiation, and plan defense designed to control costs and protect plan assets.
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Episode 233: Empowering Plans: P194 – The Rapid Evolution of the Pregnant Workers Fairness Act
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Just like the development of a child, regulations evolve in their ability to walk and talk over time. Join Jen McCormick and Kelly Dempsey as they go through the evolution of the Pregnant Workers Fairness Act – from passage in late 2022 to the final rules that took effect on June 18, 2024. They also discuss current court challenges where two courts…
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Episode 232: Empowering Plans: P193 – Stopping Esophageal Cancer In Its Tracks
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In this episode of Empowering Plans, The Phia Group’s CLO – Ron Peck – sits down with experienced surgeon, Dr. Victoria Lee, to discuss a very dangerous – and costly – threat. Esophageal cancer is generally considered to be a death sentence, and historically screening options are invasive and costly, resulting in a low uptake. With the introduction…
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Episode 231: Empowering Plans: P192 – Places, Promises, and Plan Documents
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In this installment of The Phia Group’s Empowering Plans podcast series, attorneys Jon Jablon and Cindy Merrell discuss a health plan that lost its ERISA protections because of a pre-cert snafu. Specifically, the provider was quoted benefits at U&C, but that’s not quite what the SPD said – so the court called it a promise outside the SPD, and the s…
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Episode 230: Empowering Plans: P191 – Derby Reflections and Gambles on Healthcare Strategies (Part 2)
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In this concluding episode of our special two-part series on the Empowering Plans Podcast, Adam Russo and Corey Crigger return to unpack more significant developments in the self-funded space. This episode focuses on Walmart’s surprising withdrawal from the healthcare arena—a sector it heavily invested in just a year ago. Listen as they analyze the…
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Episode 229: Empowering Plans: P190 – Derby Insights and Gambles on Healthcare Strategies (Part 1)
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Join us for a captivating two-part episode of the Empowering Plans Podcast. Adam Russo, CEO and Founder of The Phia Group, is back alongside Corey Crigger to delve into the exhilarating 150th Kentucky Derby and share why Corey’s insights are indispensable. This episode also addresses pressing concerns in the self-funded sector that are crucial for …
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Episode 228: Empowering Plans: P189 – SCOTUS Showdowns and Derby Delights
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The Empowering Plans podcast gets a southern infusion in this very Kentucky-centric podcast! Cindy Merrell and Corey Crigger get together to discuss the 150th running of the Kentucky Derby. Before you hear about all things Derby, Cindy and Corey review two impactful Supreme Court cases that were argued in the last session and discuss the implicatio…
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Episode 227: Empowering Plans: P188 – Fiduciary Duties in the Spotlight – Lewandowski v. Johnson and Johnson
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Attorneys Brady Bizarro and Andrew Silverio discuss the pending case of Lewandowski v. Johnson & Johnson, a lawsuit brought against plan fiduciaries for violating their fiduciary duties under ERISA. How did they violate those duties? By failing to negotiate drug prices and sufficiently oversee their PBM or investigate alternatives. No matter who wi…
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Episode 226: Empowering Plans: P187 – Decoding ACA FAQ #66: Essential Health Benefits Unpacked
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Listen in as Kelly Dempsey and Brian O'Hara hit it out of the park in this Empowering Plans episode about Essential Health Benefits (EHBs)! The regulating bodies are at it again and issued ACA FAQ #66 on April 2, 2024! Listen in for a quick refresher on EHBs - how they started, where they are now, and where we’re going - and Phia’s interpretation a…
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Episode 225: Empowering Plans: P186 – Xenotransplantation: A Potential Game Changer for Self-Funded Plans
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Ham it up with attorneys Nick Bonds and Jen McCormick from the Phia Group as they dive into the groundbreaking world's first successful genetically engineered pig kidney transplant at MGH in Boston. Explore the details of this medical breakthrough, its implications for the healthcare industry, and the considerations for the future of dialysis, plan…
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Episode 224: Empowering Plans: P185 – Weighing the Options
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Over the last twelve months we have seen major interest in GLP-1s (Semaglutide- Ozempic / Wegovy and Tirzepatide – Mounjaro / Zepbound). Although GLP-1s have been around for years as a treatment for diabetes, the recent popularity is due to their use as a weight loss drug. Join Ron Peck and Corey Crigger as they discuss the impact this surge in dem…
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Episode 223: Empowering Plans: P184 – State of the Union, 2024
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In his third State of the Union address, President Biden touted his administration’s record and outlined the issues he and his team will likely be campaigning on heavily as the 2024 presidential race kicks off in earnest. Sprinkled throughout were a number of policy wish list items, including some key healthcare initiatives that we’ll be keeping a …
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Episode 222: Empowering Plans: P183 – The Therapeutic Equivalence Approach: A New “Pill”ar of Contraceptive Coverage
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The DOL recently issued new guidance on the long-standing contraceptive coverage mandate, and this time they took a different approach. Instead of clarifying prior guidance or issuing novel interpretations of the law, the DOL is giving health plans an alternative way to comply with the contraceptive coverage mandate: either follow the prior guidanc…
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Episode 221: Empowering Plans: P182 – Navigating Post-Settlement Fund Pursuits
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Attorneys Andrew Silverio and Cindy Merrell discuss a newly decided case which provides a roadmap for pursuing settlement funds after disbursement. Who has the burden of proof when the funds have been dissipated? What is lowest intermediate balance rule?
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Episode 220: Empowering Plans: P181 – Chevron Deference in Peril – What It Could Mean for Healthcare Regulations
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In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O’Hara discuss the legal doctrine involved in two cases now before the Supreme Court – Chevron deference. They’ll explain what it means, why it is important for federal agency action, and how it impacts the entire healthcare industry. With a decision expected by this…
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Episode 219: Empowering Plans: P180 – The Continuing Evolution of MHPAEA
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One might think they’re listening to a broken record when hearing Jennifer McCormick and Kelly Dempsey discuss the ever-shifting landscape of the Mental Health Parity and Addiction Equity Act (MHPAEA), but alas, this is a brand new podcast! As we start 2024, we are reframing our mindset and are making some changes to address the evolving MHPAEA reg…
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Episode 218: Empowering Plans: P179 – Higher Healthcare Prices (Made From Concentrate)
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The trend of provider consolidation is primed to pick up pace in 2024, distilling some areas into ever more highly concentrated healthcare markets. Ron Peck and Nick Bonds break down how this concentration impacts the costs of healthcare and can drive costs upward for employers and employees alike. With fewer provider options, higher prices, and pa…
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Episode 217: Empowering Plans: P178 – Back to December (Phia’s Version)
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It is the last podcast of the year, and you know All Too Well that it is Phia’s 2023 year-in-review! Sparks Fly as Kendall Jackson and Corey Crigger talk about how Everything in PGC and Provider Relations Has Changed in 2023. If you need to catch up on anything from the No Surprises Act to Gag Clause Attestations, You Need To Calm Down and Stay Sta…
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Episode 216: Empowering Plans: P177 – Entering the Danger Zone: Cross-Plan Offsetting
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Attorneys Jon Jablon and Cindy Merrell discuss the practice of cross-plan offsetting and the recent settlement between the Department of Labor and EmblemHealth Inc. Who wins and who loses when a TPA decides to use cross-plan offset?
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Episode 215: Empowering Plans: P176 – Copay Accumulator Programs Take a Hit: What’s Next?
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Attorneys Brady Bizarro and Andrew Silverio discuss a recent federal court decision that saw drug manufacturers and patients alike score a win against copay accumulator programs – programs that help maximize the manufacturer assistance available to patients but decline to count those amounts toward deductibles and out-of-pocket maximums. With the l…
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Episode 214: Empowering Plans: P175 – No Surprises Act Brings More Surprises & Other Surprises for 2024
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Join Provider Relations Senior Attorney, Brian O’Hara, and Vice President of Consulting, Kelly Dempsey, for a quick rundown of changes to be prepared for as we near 2024. While there are the regular recurring changes to ACA and IRS out-of-pocket limits, this podcast will uncover a couple lesser-known items hidden in some NSA proposed rules and a co…
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Episode 213: Empowering Plans: P174 – PCORI and Parity and Lawsuits, Oh My!
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It’s the spookiest time of the year, and I’m not just talking about renewal season. In this Halloween episode of the Empowering Plans podcast, Jennifer McCormick and Nick Bonds talk through some of the scary issues creeping up on health plans: rising PCORI fees, proposed regulations on mental health parity rules, and two fascinating court cases tha…
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Episode 212: Empowering Plans: P173 – Gene-y in a Bottle: A Magical Overview of Cell and Gene Therapy
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Your wish is our command! Join Ron Peck and Corey Crigger as they discuss how this emerging treatment can impact self-funded health plans. With prices as high as $3.5 million dollars, you can’t just wish for a strategy for dealing with these therapies, you must plan for it. Ron and Corey discuss the motivations to cover, the future benefits, and th…
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Episode 211: Empowering Plans: P172 – Navigating the Gag Clause Prohibition
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In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson delve into the issue of the gag clause prohibition, a mysterious law that continues to confound the self-funded industry. With the first attestation requirement approaching at the end of 2023, now is the time to make sure you know what needs t…
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Episode 210: Empowering Plans: P171 – Mass Torts 101
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From time to time, do you hear about mass torts in the news but feel like you could use a little more background knowledge? Look no further than the latest edition of the Empowering Plans podcast series, (“Mass Torts 101”) in which attorneys Cindy Merrell and Lisa Hill explain the difference between the two types of mass tort cases -- class action …
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Episode 209: Empowering Plans: P170 – PSA on the NSA
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It’s 10’o clock, do you know where your IDR determinations are? Join Brian O’Hara and Corey Crigger as they issue a public service announcement on the state of the No Surprises Act, and specifically the challenges with the IDR process. Friends don’t let friends miss this podcast! In addition to the PSA on NSA, Corey discusses a case study highlight…
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Episode 208: Empowering Plans: P169 – Let’s Keep Learning - Back to (Law) School
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In the latest edition of the Empowering Plans podcast series, “Let’s Keep Learning - Back to (Law) School,” Attorneys Kelly Dempsey and Corey Crigger are here to take us all back to school! Listen as they discuss renewal season preparation items and a variety of late breaking lawsuits that pertain to multiple aspects of the self-funded industry. Fr…
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Episode 207: Empowering Plans: P168 – “Drafting” Plan Exclusions
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In this episode of Empowering Plans, Andrew Silverio and Kevin Brady discuss the unanticipated costs of playing pickleball and then “draft” their favorite (and least favorite) plan limitations and exclusions. Let us know who you think had the better picks!
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Episode 206: Empowering Plans: P167 – Who is a Fiduciary and Does it Even Matter? Lawsuits Abound!
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In this episode of Empowering Plans, The Phia Group’s Chief Legal Officer – Ron Peck – and Sr. VP of Consulting – Jennifer McCormick, analyze recent lawsuits involving self-funded plan sponsors and their third party administrators, and accusations of fiduciary breach on the part of TPAs. We delve into whether TPAs can be fiduciaries, what this mean…
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Episode 205: Empowering Plans: P166 – Delving Into Dobbs, One Year In
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In the latest episode of Empowering Plans, attorneys Nick Bonds and Kendall Jackson discuss the changes that have occurred in the past year following the Supreme Court’s decision in Dobbs. How will new abortion laws affect self-funded plans and what are the implications for their participants? Tune in to learn how plans can navigate these changes.…
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Episode 204: Empowering Plans: P165 – Artificial Intelligence Meets Subrogation
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We are halfway through 2023, and Artificial Intelligence (AI) remains one of the year’s hottest topics, particularly in the worlds of business and healthcare. In the latest edition of The Phia Group’s Empowering Plans podcast, Attorneys Jon Jablon and Cindy Merrell zero in on how AI could have a monumental impact on the field of subrogation within …
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Episode 203: Empowering Plans: P164 – The Key to a Successful Self-funding Experience: Knowledge!
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With many self-funded employers entering the field from a world where their benefits are “set it and forget it,” educating plan sponsors about their obligations, relationships, opportunities, and risks is often the difference between retaining and losing a client. Attorneys Andrew Silverio and Christopher Aguiar muse about the challenges arising wh…
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Episode 202: Empowering Plans: P163 – ChatGPT: Disrupting the Healthcare Industry
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In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O'Hara provide an overview of ChatGPT, the artificial intelligence chatbot developed by OpenAI, and describe how it is disrupting the healthcare industry. In particular, they focus on one emerging use for the technology - acting as a virtual assistant for patient car…
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Episode 201: Empowering Plans: P162 – Mind the Gap 2.0: Don’t be Afraid to Ask for a Handbook
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In this episode of Empowering Plans, Kelly Dempsey and Kevin Brady outline the relevant details provided within our Handbook Gap Free Reviews. They provide a description of the service, the case studies which gave rise to this service and describe why a review of the Handbook is more important now than ever before!…
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Episode 200: Empowering Plans: P161 – New Challenges to Old Favorites - NSA, ACA, and more (Acronyms)!
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In their latest podcast, Attorneys Nick Bonds and Corey Crigger are back to discuss the No Surprises Act (NSA) and the Affordable Care Act (ACA). Join them as they provide an overview of each of these laws and the recent legal challenges out of Nick’s home state of Texas. Will payment determinations resume? Has the ACA finally been struck down? Tun…
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Episode 199: Empowering Plans: P160 – How the Ending of COVID-era National Emergency Impacts Your Health Plan
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On April 10, President Joe Biden signed a bipartisan congressional resolution to terminate the U.S. national emergency in response to the COVID-19 pandemic—weeks before the development was supposed to occur in conjunction with a separate public health emergency expiring on May 11. Unsurprisingly, in the wake of such a stunning announcement, group h…
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Episode 198: Empowering Plans: P159 – Putting the Patient First: Challenges to Common TPA Operations
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In this episode of The Phia Group's Empowering Plans podcast, attorneys Katie Malkin and Jon Jablon take a dive into three aspects of TPA operations designed to try to make the TPA's job more manageable: simplifying EOB denial codes, sending family EOBs, and recouping overpayments by offsetting. These are three common strategies used by TPAs, but a…
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Episode 197: Empowering Plans: P158 – Seek and Ye Shall Find
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In the world of subrogation, there’s (almost) always more funds to recover, you just have to go searching for them—even if that means in unconventional places. In their latest podcast, attorneys Chris Aguiar and Cindy Merrell discuss how, particularly in regards to auto accidents involving participants who have substandard coverage, there is a heig…
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Episode 196: Empowering Plans: P157 – New TPA Liabilities – Section 1557
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One of the healthcare trends we have been following so far in 2023 is expanded TPA liabilities. In this edition of the Empowering Plans podcast, attorneys Brady Bizarro and Andrew Silverio discuss a recent federal court case in which a TPA was found liable for violations of the ACA’s Section 1557. Despite numerous defenses raised by the TPA, many o…
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Episode 195: Empowering Plans: P156 – Accommodating Reasonably: Navigating the ADA and PWFA in 2023
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On this episode of Empowering Plans, Kelly Dempsey and Kevin Brady provide some valuable insights into the reasonable accommodation process under the ADA and PWFA. The PWFA, which will be effective this June, expands the scope of existing federal law with respect to accommodating employees with known limitations related to pregnancy, childbirth, or…
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Episode 194: Empowering Plans: P155 – The State of the Union 2023: Phia’s Take
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The State of the Union has always served as an important bellwether for our country, but also, for our industry, revealing what the current administration’s healthcare policies will be going forward, and in some cases, which ones enjoy bipartisan support. In this special edition podcast, join attorneys Ron Peck and Brady Bizarro as they break down …
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Episode 193: Empowering Plans: P154 – No Ordinary Time in Healthcare
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Corey Crigger and Nicholas Bonds cover a lot of ground in the newest installment of The Phia Group’s Empowering Plans podcast: Whether it’s the National and Public Health Emergencies starting to wind down or what state legislatures have in store for non-profit hospitals that overcharge or Amazon creeping into the healthcare space, Phia’s attorneys …
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Episode 192: Empowering Plans: P153 – Living Up To Expectations
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Over the last decade, The Phia Group’s leaders have made quite a few predictions. There have been some hits and misses. Join attorneys Ron Peck and Jen McCormick as they discuss past predictions, their predictions for 2023, and what the best health plans need to do to stay ahead of the game this year!…
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Episode 191: Empowering Plans: P152 – The Contemporary Fiduciary: Emerging Law on an Old Topic
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In this installment of The Phia Group’s Empowering Plans podcast, join attorneys Katie MacLeod and Jon Jablon as they discuss fiduciary status, both traditionally and in the new age of self-funding. This industry is faced with changes all the time, even to some of its oldest rules; in the spirit of consumer protection, the legal and regulatory wind…
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Episode 190: Empowering Plans: P151 – The Who, What, and When of Offsetting Benefits
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In this installment of The Phia Group’s Empowering Plans podcast, attorneys Chris Aguiar and Cindy Merrell discuss offsetting benefits and when a Plan may consider it.
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Episode 189: Empowering Plans: P150 – Manufacturer Assistance Programs
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Attorneys Brady Bizarro and Andrew Silverio discuss manufacturer/copay assistance programs and outline some of the different approaches being utilized to manage specialty drug spending. Also on the agenda is a current lawsuit against one such program administrator, and how the landscape might be shaped in the coming months.…
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In recent history there have been several rules that have been amended and re-amended (or just overturned and new rules published). Join Kelly Dempsey and Kevin Brady as they explore the ever-changing world of employee classification rules. The 2021 rule is viewed as leaving workers vulnerable to misclassification and was inconsistent with existing…
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Episode 187: Empowering Plans: P148 – The Ever Changing Times of Healthcare
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“It’s an ever changing time…” in the healthcare landscape. Corey Crigger and Nick Bonds are back on the podcast mics to discuss some of the more interesting developments they’ve seen in 2022. Tune in to be sure these developments aren't burdensome and rest assured that the dreams you believe in will still come true.…
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Episode 186: Empowering Plans: P147 – Transparency & More: Burning CAA/NSA FAQs
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In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jen McCormick and Jon Jablon bring up some of the most common questions that The Phia Group’s consulting team has been asked to field over and over again. From the so-called broker compensation rules to a TPA’s obligations related to a group’s No Surprises Act compliance, J…
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Episode 185: Book of Russo: Chapter 5
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17:59
In the latest episode of The Book of Russo, tune in to find out what The Phia Group’s CEO, Adam Russo, and guest host, Mike Ferguson, President & CEO of the Self-Insurance Institute of America (SIIA), have to say about SIIA’s 2022 National Conference, the history of SIIA, and what to expect from SIIA in years to come.…
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Episode 184: Empowering Plans: P146 - A Possible Threat to a Plan’s Discretionary Authority
17:48
17:48
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Leuk
17:48
Currently before the Senate, a new bill has been announced that would ban all references to a plan administrator’s discretionary authority, as well as remove all deference courts give to their claims determinations. Regardless of whether this bill will be passed, what does this and similar rhetoric say about public and political attitudes towards s…
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