The Phia Group's Podcast: Recent Episodes
The Phia Group
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.
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. From civil courts hearing cases about NSA administrative issues all the way to ACA compliance (or lack thereof) there is something in this podcast for everyone. Once you listen to the podcast - class dismissed!
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!
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 means, and whether it even matters when it comes down to how administrators manage plans. Finally, are plan sponsors signing contracts enabling TPAs to do things contrary to ERISA, and who is to blame when this is the case? Anyone and everyone handling self-funded plan assets needs to tune into this one!
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.
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 continues to have a monumental impact on the field of subrogation within the larger context of healthcare law.
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 when self-funded plans aren’t educated about their benefit offerings, the risk mitigation mechanisms, and the cost containment tools being utilized to ensure the plan’s viability.
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 federal court decisions, thus the current administration is seeking to make a change. Tune in to learn more and why this rule matters to self-funded health plans.
“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.
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, Jen and Jon highlight some of the main points to keep in mind when making important decisions regarding your business.
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.
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 self-funded health plans? Ron Peck, Chief Legal Officer, and attorney Kaitlyn MacLeod are here to talk about this and more. Enjoy!
Some strong statements about the COVID-19 Pandemic were made during President Biden’s 60 Minutes Interview that aired on Sunday, September 18, 2022. Join Kelly Dempsey and Kevin Brady in discussing those statements, the current status of the COVID-19 rules and plan language, and the rising numbers and cost related to COVID long-haulers.
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, Dr. Jeffery Gold, have to say about Direct Primary Care and why Dr. Gold decided to open his own practice in Massachusetts.
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Andrew Silverio, discuss patient assistance programs. They explain what these programs are, how they have been utilized in the industry, and the latest regulations and litigation surrounding them. Tune in to find out what plan sponsors need to know!
In this installment of the Empowering Plans podcast, attorneys Chris Aguiar and Cindy Merrell, discuss the murky waters of wrongful death and healthcare subrogation claims.
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, Ernie Clevenger, have to say about Ernie’s famous Saturday night newsletter, CareHere, and much more.
In this installment of The Empowering Plans podcast, attorneys Nick Bonds and Corey Crigger discuss two recent shifts in the healthcare landscape. The FDA’s stance on OTC hearing aids and recent developments that show that not all debt is created equal, especially medical debt.
In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jen McCormick and Jon Jablon discuss the age-old topic of stop-loss gaps, with a modern twist. Emerging law and industry trends color so many decisions that self-funded plans and those that service them must make on a daily basis, and one player that sometimes gets forgotten about is stop-loss. Since stop-loss coverage expectations don’t always align with reality, health plans, TPAs, and brokers need to be proactive, to find potential gaps and try to rectify them before they evolve into real problems.
In the wake of the COVID-19 pandemic, the government has announced that we are facing another crisis – one on mental health. Participants are clamoring for more access to mental health care than ever before. The COVID-19 pandemic only highlighted the lack of availability of mental health care in the US, including care that is covered by plans. Ron Peck, Chief Legal Officer, and attorney Kaitlyn MacLeod are here to talk about what plans are doing to address the mental health crisis and how mental health parity comes into play for plans, patients, and providers.
In this episode of the Empowering Plans podcast, attorneys Chris Aguiar and Cindy Merrell, discuss potential obligations of health plans to their stop loss carriers in the event of a recovery through subrogation.
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, Dr. Marty Makary, have to say about price transparency, price gouging, and who is typically responsible for the high cost of care.
On June 24th, the U.S. Supreme Court handed down one of its most controversial and impactful decisions in half a century by overturning Roe v. Wade. This decision has sweeping implications for group health plans. In this special edition of the Empowering Plans podcast, The Phia Group’s Chief Legal Officer, Ron Peck, is joined by attorneys Jen McCormick and Brady Bizarro to unpack the Court’s opinion, what’s likely to happen next, and most importantly, how health plans should respond to this historic ruling.
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Andrew Silverio, break down the Supreme Court’s ruling in the Marietta case on dialysis carveouts. What does the ruling mean for self-funded plans that wish to carve out dialysis claims? Our experts dig deep into the legal analysis and explain how plans can stay within the parameters of this decision. Finally, they address important points raised by the dissent and consider the broader impact on the industry.
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Andrew Silverio, break down the Supreme Court’s ruling in the Marietta case on dialysis carveouts. What does the ruling mean for self-funded plans that wish to carve out dialysis claims? Our experts dig deep into the legal analysis and explain how plans can stay within the parameters of this decision. Finally, they address important points raised by the dissent and consider the broader impact on the industry.
In the first episode of The Book of Russo, tune in to find out what The Phia Group’s CEO, Adam Russo, has to say about the new podcast series, healthcare transparency, and so much more.
In this episode of Empowering Plans, join Kelly Dempsey and Kevin Brady, as they discuss the important considerations surrounding rehired employees and breaks in service. This dynamic duo covers a number of items including the 13/26 week rule, the rule parity, and the need to add plan provisions which account for these situations.
In this episode of The Phia Group’s Empowering Plans podcast, attorneys Nick Bonds and Corey Crigger, discuss Direct Primary Care (DPC). This was a hot topic at a recent conference Nick attended and a subject near and dear to Corey. Join them as they discuss the benefits and practical issues to consider when looking to this tremendous option for augmenting your employee benefits plan.
In this episode of The Phia Group’s Empowering Plans podcast, attorneys Jen McCormick and Jon Jablon discuss some emerging law and trends that impact the self-funded industry, with an emphasis on what it means for the TPA/employer dynamic. Relationships are key in this industry, but since the law imposes responsibilities on health plans that often can’t be met without significant help from a TPA, things can get a bit messy. There’s a lot of content to cover on this one, and Jen and Jon try to at least scratch the surface of this complex topic.
Congress has proposed a $35 cap on patient cost-sharing for a month supply of insulin. Join Attorneys Cindy Merrell and Micah Iberosi-Parnell, as they discuss the insulin cost crisis, Congress’ band-aid on insulin prices, and what’s really needed to lower costs for employers and patients.
The CAA, passed in part due to the rising mental health issues, added enhanced DOL enforcement mechanisms. Join special guest Jen Berman of MZQ, and Jen McCormick, as they discuss the DOL’s evolving approach on MHPAEA which is moving from a "compliance assistance" model to a "proactive enforcement" model. This approach puts a ton of pressure on plan sponsors – administrative, compliance, logistical – and plans need to be prepared.
On this week’s episode of Empowering Plans, Attorneys Chris Aguiar and Cindy Merrell, discuss the balancing act of health plan members’ reduction requests and Plan’s fiduciary duties, why a reduction can be in the Plan’s best interest, and more. Listen in as we dive deep into reduction requests and Plan’s fiduciary duties.
With one year under his belt, President Biden delivered his first State of the Union address, in which he showcased his domestic policy agenda. In this episode of the Empowering Plans podcast, Brady Bizarro and Andrew Silverio break down the important healthcare policy items the president discussed, and as importantly, which ones he did not.
On this week’s episode of Empowering Plans, Kelly Dempsey and Kevin Brady discuss over-the-counter COVID testing and the complications surrounding up-front payment by participants with account-based plans (HSA, FSA, HRA).
February 10 marks a full year since the requirement to provide a written report document a plan’s comparative analysis of its NQTLs took effect. In today’s podcast, Jon Jablon and Nick Bonds discuss some of what they’ve learned from a year’s worth of analyzing NQTLs, some practical considerations for health plans, and their takeaways from the recently-published report on MHPAEA compliance from the DOL, HHS, and Treasury.
This week on Empowering Plans, Jen McCormick and Katie MacLeod discuss the controversial new OTC COVID-19 Testing coverage requirement that went into effect on January 15, 2022 for plans – how it interacts with other COVID-19 coverage requirements, what plans need to cover and available safe harbors, and how plans can be prepared for compliance. This won’t be the last you hear of this topic, plans should not delay in getting their action plan and policies in place.
Kicking off the first episode of Empowering Plans in 2022, Phia’s Chief Legal Officer, Ron E. Peck, and Attorney Micah Iberosi-Parnell, talk value-based care, what it is, where it’s at right now, and where it’s headed. Listen for a preview of what action self-funded plans can begin taking now to reduce costs without sacrificing the quality of coverage.
This week on Empowering Plans, Rebekah McGuire-Dye and Lisa Hill bring you back to the basics of recovering subrogation dollars and identifying subrogation opportunities through an entertaining holiday story. Listen in to hear Rebekah's holiday story and how this story relates to multiple subrogation cases.
In this episode of Empowering Plans, Attorneys Chris Aguiar and Cindy Merrell, discuss what a health plan should do in the event of a pesky U.S.C. 1024(b)(4) records request. Tune in for all of the details!
In this episode of the Empowering Plans podcast, join attorneys Brady Bizarro and Andrew Silverio as they discuss important developments in dialysis case law. Earlier in November, the Supreme Court agreed to hear arguments in a case which could settle an important question about the Medicare Secondary Payer Act and have important ramifications for plan language and payment methodologies. Brady and Andrew trace the history of the case and the differences in legal interpretation by the lower courts. Finally, they offer some predictions about how the Court may rule and the impact it could have on the industry.
This week on Empowering Plans, Kelly Dempsey and Kevin Brady discuss the controversial OSHA vaccine mandate rules – where they started, where they stand now, and the many legal challenges that have arisen. This won’t be the last you hear of this topic and despite the legal challenges, employers should not delay in getting their action plan and policies in place.
This week on Empowering Plans, Nick Bonds and Jon Jablon discuss a highly nuanced topic that has been the bane of many health plans: organ transplants. From interspecies organ transplantation to COVID’s effect on the global organ trade, it’s an evolving topic with serious implications on healthcare.
Join The Phia Group’s CLO, Ron Peck, and SVP of Consulting, Jen McCormick, as they dissect the No Surprises Act and reveal how and why there will be confusion regarding what constitutes a basis for appeal, and what should be disputed per the NSA. This, along with updates on the cost of COVID testing, mandatory vaccine orders, and more are in store with this episode of Empowering Plans!
In this episode of Empowering Plans, Attorneys Rebekah McGuire-Dye and Cindy Merrell, discuss how current Workers’ Compensation regulations impact health plans, and who is responsible for employee’s Covid-19 related claims.
This week on Empowering Plans, Attorneys Chris Aguiar and Cindy Merrell, discuss what happens when limited settlement funds force Plans to consider a reduction. Listen in to get all of the details.
This week on Empowering Plans, there are important COVID-19 vaccine updates to discuss. Pfizer’s vaccine was granted full FDA approval, booster shots are coming, and employers are debating whether and how to implement premium penalties for the unvaccinated. What do employers and their plans need to know? Join Attorneys Brady Bizarro and Kelly Dempsey as they break it all down for you.
This week, take a break from COVID headlines with Andrew Silverio and Nick Bonds, as they discuss President Biden’s recent executive order on right to repair. How does promoting right to repair, a policy traditionally thought of in the context of automobiles and consumer electronics, factor into the healthcare space? Can right to repair reduce healthcare expenses, or is it a threat to the patient safety and intellectual property rights?
In this episode of Empowering Plans, Attorneys Nick Bonds and Brady Bizarro, discuss a number of healthcare topics to keep you updated on the latest topics buzzing around the industry.
In one of the most energetic Phia podcasts to date, our Chief Legal Office – Ron Peck, and our Sr. VP of Consulting – Jen McCormick, discuss key mistakes and false beliefs dominating the media, politics, and the general public, before dissecting how those errors have impacted recent rulemaking. If you want to be both entertained and enlightened, this is the must-listen episode!
In this episode of Empowering Plans, Rebekah McGuire-Dye and Lisa Hill talk about Medicaid and subrogation & reimbursement. SCOTUS has recently agreed to hear a Medicaid case involving conflicting state court and federal court decisions out of Florida, and whether or not the term “medical expenses” covers ALL medical expenses, or only past medical expenses, for purposes of subrogation & reimbursement. Listen in as Rebekah and Lisa discuss this case and its potential ramifications.
Subrogation Attorneys Cindy Merrell and Maribel Echeverry McLaughlin discuss healthcare subrogation in the post-Covid environment, and the difficulties faced during the international pandemic. What can Plans expect now that the courts are reopening, and drivers are back on the roads, and how Plans can assist in getting higher recovery numbers.
In this episode of Empowering Plans, Attorneys Chris Aguiar and Andrew Silverio, discuss some evolving issues and recent developments, including whether a participant can be deemed a plan fiduciary after a third party recovery, and the current state-run of state drug importation programs.
In this episode of Empowering Plans, attorneys Nick Bonds and Jon Jablon discuss one of the most mysterious topics of the CAA: the Non-Quantitative Treatment Limitation analysis now required by the Mental Health Parity and Addiction Equity Act. Not surprisingly, this analysis is anything but straightforward, and certainly no easy task for health plans – especially with very little helpful regulatory guidance. Jon and Nick are here to talk about what the heck NQTLs actually are, what the analysis entails, and how health plans can best protect themselves from the DOL’s wrath!
In this episode of Empowering Plans Kelly Dempsey and Kevin Brady revisit a subject quite popular at the beginning of the pandemic; testing for COVID-19. Plan members don’t have to pay for COVID-19 tests, but group health plans do. Unfortunately, there are no limits in place on how much the plan has to pay for those tests. Listen to this week’s episode to hear about the current state of pricing for these tests, and how we see things shaping up moving forward!
In this episode of the Empowering Plans Podcast, Tim Callender is joined by Jordan Feldman, the CEO and Co-Founder of Rightway Healthcare, along with Linda Pestana, the Director of HR at Phia. For the past two years, Phia has been a Rightway client, reporting a 6.8X ROI. Tim and Jordan discuss why Rightway got started and how it's delivering a "doctor in the family" experience for all members. Linda also shares the impact it's had on her — both as the HR / Benefits leader and as a direct user of the service. Tune in to hear how Rightway is making an impact!
As COVID-19 infection rates appear to be trending downwards in most areas in the U.S., employers across the country are hard at work on reopening plans in anticipation of the lifting of most occupancy limitations to slow the spread of the virus. The big question employers are asking themselves is whether to mandate COVID-19 vaccinations for employees returning to the workplace to ensure a safe work environment.
Phil and Brady take a deep dive into this issue discussing compliance considerations implicated when considering mandating vaccination as we as explore limitations, risks, and current trends being established by employers that have already reopened.
In this episode we welcome back to the mic EVP and General Counsel, Ron Peck, as well as SVP of Consulting, Jen McCormick. These industry legends discuss the No Surprises Act, its likely impact on both the payer and provider industries, and provide listeners with guidance on what they need to do now, to ensure compliance when it goes live.
Legal Compliance & Regulatory Affairs Consultant, Phil Qualo, and Vice President of Consulting, Kelly Dempsey Esq., explore the phenomena surrounding COVID-19 long haulers. Although the term “long haulers” trigger thoughts of cross country truck driving, it has actually been used as a common reference to people who have been infected with the COVID-19 virus and have not fully recovered for weeks, months, and even up to a year after first experiencing symptoms. This episode provides personal insight into the challenges that these long haulers are facing that impact both employer and benefit considerations, including access to disability benefits and health care.
In this episode of Empowering Plans, Jen McCormick and Andi Goodman discuss the future of vaccinating vulnerable populations such as pregnant women and children, and the importance of vaccinating children in achieving herd immunity. What are the next steps for expanding vaccine eligibility? What do employers need to know if they are considering requiring their staff to get vaccinated before returning to work?
Join Timothy Pope, an Attorney in the Provider Relations Department, and Garrick Hunt, Phia’s Sales Manager, as they host a candid discussion about the harmful effects that the sweeping lockdown has had on families, and in particular on children with disabilities. Since the closing of most public schools, many children with disabilities have suffered immensely. As a parent of a child with mental disabilities, Garrick dives into his first-hand account of the lockdown’s impact on his family.
In this episode of the Empowering Plans podcast, Nick and Brady talk through some developing trends in ERISA litigation. Do fiduciary duties apply to protection of plan data? Could a data breach lead to claims under ERISA and HIPAA? What steps do ERISA fiduciaries need to take? Listen in as we explore where things stand, and where they might be heading.
In this episode of Empowering Plans, join Brady Bizarro and Jen McCormick as they have a conversation about the impact of COVID-19 on employers, health plans, and employees. How should employers be dealing with mental health, physical health, and productivity issues? What steps can health plans take to reduce claims exposure? How are employers planning to return to the office later this year? It may feel like Groundhog Day, but our advice is certainly not more of the same.
In this episode of the Empowering Plans podcast, Ron and Brady discuss the inauguration of President Biden and what his presidency could mean for healthcare policy. With Democrats in control of government, a lot could get done in the first 100 days - on COVID-19 relief, the ACA, and rolling back Trump-era rules. Join us as we break it all down.
In this episode of the Empowering Plans Podcast, Ron Peck is joined by Corey Crigger, an attorney in the Provider Relations Department. Ron and Corey discuss balance billing in the COVID world, medical tourism, and vaccine passports. What can we expect in the not so distant future? No one has a crystal ball, but Ron and Corey offer an insight on the implications of a tiered vaccine rollout that may not be uniform and business requiring proof of passport. Also, what parts of the pandemic does Corey see as a positive? Tune in to find out!
In this episode of the Empowering Plans Podcast, Brady Bizarro is joined by a new face at Phia, Mitch Hilbert. Listen in as Brady and Mitch discuss how balance billing has been on an uptick during COVID, and how patients can possibly prevent this from occurring. Is Congress doing anything? What can we expect in the near future. Find out in our latest Empowering Plans Podcast.
In this episode of Empowering Plans, Brady is joined by Attorney Andrew Silverio. They discuss current COVID-19 vaccine candidates and everything health plans and employers need to know about them. When can we expect the first vaccines to arrive? Do health plans have to cover them at full price? Can (or should) employers make this vaccine mandatory? Join us to find out.
In this episode of the Empowering Plans Podcast, Ron Peck, Brady Bizarro, and Nick Bonds reunite to discuss their developing thoughts on the presidential election results. They speculate as to what moves a Biden administration can make on health care with a potentially Republican-controlled senate, and what effects those moves could have in the self-funded industry. They also discuss California v. Texas and try to anticipate how the Supreme Court might rule on the fate of the ACA. Lastly, they talk through the exciting news of a potentially viable coronavirus vaccine.
In this episode of Empowering Plans, Ron and Brady are joined by Attorney Nick Bonds to discuss the 2020 election results. For now, it looks like we will have a new president in 2021. What will that mean for the healthcare industry? If the Senate stays in Republican control, is a public option likely? Will Obamacare be replaced? What will happen to popular issues such as prescription drug reform and surprise billing bans? We are covering all of the angles and breaking down all of the possibilities.
In this episode of Empowering Plans, Brady is joined by Attorney Nick Bonds. They break down the final presidential debate of the campaign season, focusing in on the candidates’ healthcare plans. They discuss “Bidencare” as well as what would actually happen if the Affordable Care Act is finally found unconstitutional. To cap things off, they offer election predictions – which states will decide the election? Will Democrats take over the Senate? This is one October surprise you don’t want to miss!
In this episode of the Empowering Plans podcast, Ron Peck and Brady Bizarro take you behind the scenes, avoiding the bright lights of presidential town halls and Supreme Court confirmation hearings. What is really going on? Is Medicare-for-All still a threat? Where is the Trump administration’s healthcare plan? How will a potential Justice Amy Cony Barrett rule on the Affordable Care Act case? Tune in to find out!
In this episode, Ron Peck and Brady Bizarro guide you through a chaotic week for healthcare news. What did we learn (if anything) from the first presidential debate? With COVID-19 infecting the President and much of the West Wing, what can we learn from the President’s experimental treatment? Would self-funded plans cover this treatment? What impact could all of this have on the Affordable Care Act lawsuit? Join us to find out!
In this episode of the Empowering Plans podcast, Brady is joined by Kelly Dempsey to discuss a particularly damaging impact of the pandemic that does not get much media attention: with many businesses forced to operate at reduced capacity, they still have to comply with the ACA's employer mandate. That can be very burdensome given falling revenues. What can be done by the regulators and by Congress? Find out in our latest podcast.
The COVID-19 pandemic has brought about an unprecedented wave of federal legislation in a short period of time specifically aimed at regulating employer-sponsored group health plan coverage. Similarly, the Internal Revenue Service (IRS) has followed suit and released several formal Notices aimed at extending COVID-19 relief options to cafeteria plans. In the most recent notice issued by the IRS, however, IRS Notice 2020-29, there are certain provisions that impact employer-sponsored coverage. If adopted by a cafeteria plan sponsor that also sponsors a self-funded health plan, these provisions can result in significant cost liability for the plan and create issues for stop-loss reimbursement.
In this episode of Empowering Plans, Ron and Brady assess what we learned from the candidates on healthcare policy at the virtual Democratic and Republican national conventions. Over the course of two weeks, both parties showcased their platforms; one focused heavily on restoring the Affordable Care Act and a nationwide COVID-19 response, and the other on lowering prescription drug prices and covering all pre-existing conditions. What can our industry learn from the talking points? Join us as we cover all the angles and discuss what comes next as the presidential election draws ever closer.
In this episode of the Empowering Plans podcast, Jen and Nick discuss significant developments in nondiscrimination regulations, and the implications for those in the self-funding industry. They talk through the evolution of Section 1557 of the ACA, the new final rule issued by HHS, the Supreme Court’s recent decision on Title VII of the Civil Rights Act, and the looming legal challenges as the health care field attempts to reconcile what we’re hearing from the Supreme Court and HHS. They piece together what all this means for employer-sponsored plans, and offer some advice as to how employers and plans should respond.
In this episode of the Empowering Plans podcast, Ron and Brady discuss a Catch-22 emerging in the midst of the global pandemic - as more government intervention is needed to deal with COVID-19, calls for a public option and Medicare for All grow louder. Join them as they discuss this issue and other looming threats to the industry; from uncertainty over the ACA and out of control drug prices to the disruption of employment-based health insurance.
In this special episode, Ron and Brady address recent events that has altered the world as we knew it in a matter of months, and in one notable case, in one day. The emergence of Covid-19, the resulting mandatory restrictions to daily life, and televised tragic death of Mr. George Floyd, an unarmed African American man, at the hands of law enforcement has altered our collective understanding of security and racial equality in the U.S. In a moment of time that has been compared to the Civil Rights Movement, our very own Philip Qualo, Chairperson of the Phia Diversity Inclusion Committee, joins us to provide his perspective on these issues and the importance for Americans to unite in the face of tragedy. For industry leaders who may be uncertain on how to support their workforce in this “cancel culture” era, we also share some of our own internal approaches we have adopted that have not only been well received but actually celebrated by our staff and the industry as a whole. As racial disparities continue to persist in access to meaningful healthcare, resulting in grossly disproportionate outcomes for people of color, the escalating cost of healthcare in an increasingly diverse workforce, social justice and racial equality are conversations that can no longer be ignored or kept silent.
In this episode of the Empowering Plans podcast, Ron and Brady briefly discuss Phia's new headquarters in Canton, MA. Then, they jump into a discussion about recent high-profile court cases that could shape our industry: from requiring hospitals to post their negotiated rates with insurers online to the Trump administration's latest action in the Supreme Court case that could spell the end of the entire Affordable Care Act.
In this episode, Brady Bizarro and Jennifer McCormick discuss the impact of COVID-19 on workers' compensation claims. How can we tell if employees were exposed at work? How should employers prepare for an influx in claims? What actions are state legislatures taking across the country to expand workers' compensation benefits for pandemic-related injuries? Our legal experts grapple with these questions and more.
Today, we launch a new series harkening to our Boston roots - “Wicked Awesome Wins.” Here, we will showcase our staff and some of their most successful and noteworthy wins on behalf of our clients. Join Ron and Brady as they interview Attorney Robert Martinez and explore a case in which he secured a massive balance bill write-off from a hospital using some creative tactics.
In this episode, Ron Peck and Brady Bizarro are joined by consulting attorney Nicholas Bonds. Nick describes the unique concerns facing covered entities and their business associates as more of us utilize video conferencing platforms while under quarantine. What steps should you take to keep PHI safe? Finally, Ron and Brady end on a high note, summarizing some of the positive COVID-19 news that has come of late.
Join Attorneys Brady Bizarro and Jennifer McCormick as they discuss some of the latest studies on the potential cost of COVID-19 treatment for self-funded plans, the projected impact on employer-sponsored insurance, and how they think this pandemic could change the industry.
In this public health emergency, the federal government is not the only entity taking significant action. Join attorneys Brady Bizarro and Kelly Dempsey as they dive into the unique responses we have seen from individual states and providers while evaluating their impact on the self-funded industry.
In this episode of Empowering Plans, Ron Peck and Brady Bizarro discuss the latest developments related to COVID-19, the impact on the self-funded industry, and review the contours of the Families First Coronavirus Response Act, which guarantees free coronavirus testing for all Americans as well as an expansion of paid sick days for a subset of workers.
In this special edition of Empowering Plans, Brady Bizarro and Jennifer McCormick discuss the recent outbreak of COVID-19 (coronavirus). Join them for their insight into how you should be preparing, what concerns you should have about your benefits documents, and how to navigate applicable law.
In this episode, Ron Peck and Brady Bizarro assess candidates’ (and EX-candidate’s) proposals, and what it all means for our industry.
In this episode, Adam and Ron interview industry legend, Ernie Clevenger, regarding CareHere, LLC, the future of consumer-centric medicine, technology – and most importantly – the MyHealthGuide newsletter!
In this episode, Ron Peck and Brady Bizarro discuss the first Democratic debate of 2020 and the latest ruling from a federal appeals court on Obamacare. Time could be running out, both for the ACA and for the candidates for president. You do not want to miss our take on these issues and more!
We finally did it! Join Adam Russo and Ron Peck as they discuss the different tactics used to offer Phia's employees FREE health benefits! This is not a podcast that you can afford to miss.
This is it! This is it! Ron and Brady pick apart Elizabeth Warren’s Medicare-for-All proposal, and the concept as a whole; the good, the bad, and the really bad. You can’t afford to ignore this one.
The Phia Group’s Executive Vice President and General Counsel, Ron E. Peck, and Senior Vice President of Consulting, Jen McCormick, sit down to discuss the top-rated topic chosen by Phia’s webinar listeners. Our webinar listeners spoke (hypothetically) and we listened! Make sure you tune in to find out what Ron and Jen have to say about plan documents and learn the do’s and don’ts when it comes to reviewing and updating your plan document in 2020!
Adam Russo and Brady Bizarro sit down with Craig Clemente, Chief Operations Officer at Specialty Care Management and outgoing Chairman of the SIIA Future Leaders Committee, to discuss the future of the committee and the many ways they intend on engaging the younger generation. Make sure you tune in to find out what SIIA has in store for 2020 and beyond.
Join Adam Russo and Ron Peck as they interview Shauna Mackey, The Phia Group’s Associate General Counsel. Shauna is back in New England after moving to London, and was fortunate to have had private health insurance through her husband’s company, as opposed to utilizing the public healthcare offered to all residents in England. Tune in to learn more about Shauna and her experience with both public and private healthcare throughout her pregnancy and delivery.
Join Adam Russo and Ron Peck as they interview Lyneka Hubbert, a Medical Claim Negotiator here at The Phia Group. Lyneka has worked in six different departments throughout her five years at Phia, and has more in store for her future here. Tune in to learn more about Lyneka and her experience with protecting patients from balance bills.
Join Adam Russo and Ron Peck as they interview The Phia Group’s Human Resources Manager, Linda Pestana. Learn how Linda was able to navigate our health plan and negotiate with a provider to make her son’s hearing aids affordable. Additionally, Linda discusses another story regarding Phia’s health plan, and how it has completely erased the out-of-pocket expense for a medication another employee previously paid $800.00 a month for.
Join Adam Russo and Ron Peck as they interview Jen Marsh, a dedicated employee that dates back to 2007, when Phia was one-third of the size it is today. Jen turns back time and goes over the past 12 years of her career here at Phia, from where she started as a Case Evaluator, to where she is today as the Client Satisfaction & Quality Control Manager... and you won't believe who used to work for her!
Join Adam, Pat, and this episode’s guest – Michael Vaz – to hear from a valued employee, whose experience in the industry and as a consumer of healthcare will open your eyes and help you appreciate how much difference a plan can make in a person’s life. Containing costs and rewarding employees – it’s a win-win.
Brady and Ron do what they do best, say the things you are thinking! This time, they wax poetic about Obamacare, the state of health care versus health insurance, and the political environment as we move toward the 2020 election.
Join Ron Peck as he interviews Desmond Campbell; the man, the myth, the legend. Desmond has spent time crunching numbers over the past 4 years – first for clients, now for The Phia Group. A man with experience elsewhere in the industry, Desmond will share what brought him to The Phia Group, and what keeps him here.
In this episode, learn more about the life and background of Andrew Fine, Phia’s Lead Intake Specialist. Listen in as Andrew discusses his family, the fan club behind him, compliance being the number one priority for plans, and the bittersweet nature of the Celtics. Listen in closely, as the former sports analyst might give you some insider tips!
In this episode, prepare to be enchanted by Mattie Sesin, our Director of Recovery Services. Like a toad kissed by a princess, her career has transformed – and we invite you to join the journey. Marvel at the tales of family, festivities, and food. Miss this one, and you’ll likely turn into a pumpkin.
In this episode of Empower Plans – Tales from the Plan, The Phia Group’s VP of Legal Recovery Services discusses his experiences before and after becoming a happy participant in Direct Primary Care. If you are one of the many people who’ve heard about “DPC” but still wonder how it will be received by the plan participants, tune in.
In this meaningful episode, Ron Peck tells us about his family’s battle against cancer, and lessons we can all learn from their experience. Health benefits play a role in our health and survival. You can’t afford to miss this one.
With this episode, the guys define surprise balance billing, discuss movements to curb them (at the State and Federal levels), and harass Pat “The Man” Santos as well. Stop reading this description and start listening!
In our inaugural episode of “Tales from the Plan,” our own Sr. VP of Consulting, Jennifer McCormick, opens up and candidly discusses her own experience as a consumer of healthcare and member of The Phia Group’s health plan. Jen is brutally honest, and will make you realize that anyone can be taken advantage of, and anyone can take advantage of, our nation’s healthcare system. This is mandatory listening.
Amanda Lima celebrates more than 6 years with Phia (most of that time working closely with Adam), by chatting about her time here, the company, and the amazing work she’s doing on our clients’ behalves – delving deeply into matters of excessive and abusive provider billing. This is a topic about which everyone is buzzing, and Amanda has got the dirt!
In this groundbreaking episode, Pat 'the Man' Santos – our silent producer, is silent no longer! Listen (if you dare) as he grabs the mic and goes toe to toe with our hosts. Learn of his daring escape from mediocrity, journey of self-awareness, and eventual role with The Phia Group. This is the one you’ve been waiting for. Don’t miss it.
In the latest episode of Faces of Phia, Adam and Ron reminisce on Andrew Silverio's Undergraduate adventure. Tune in for an episode filled with trips down memory lane, international drug importation, and predictions about the future of prescription drugs!
Join Adam, Ron, and Brady for a healthcare free for all where they tackle the most pressing issues facing our industry, including surprise emergency room bills, drug pricing, medical necessity, and employee incentive programs.
In the latest episode of Faces of Phia, Adam and Ron dig up tales from the days of old with future industry leader and veteran employee, Amanda Grogan. Tune in for an episode filled with trips down memory lane, tests of knowledge, and a Rumspringa?
Last night, a federal judge in Washington, D.C. ruled that the Department of Labor’s new rules that expanded the sale of association health plans (“AHPs”) violate existing law. Those rules applied to fully-insured AHPs in September 2018, to existing self-funded AHPs in January 2019, and would have permitted new self-funded AHPs on April 1, 2019. If this ruling stands, it will have a significant impact on the self-funded industry. The Phia Group will have extensive analysis of this decision in the coming days. For now, join Adam and Brady as they unpack this 43-page order and discuss what it all means for employers, TPAs, brokers, and the broader industry.
Listen in as The Phia Group’s Marketing & Accounts Manager, Matthew Painten, and Compliance & Regulatory Affairs Consultant, Philip Qualo, dissect Phia’s very own Self-funded health plan. These guys aren’t holding back and you don’t want to miss out on this podcast!
Join The Phia Group’s Ron Peck and Brady Bizarro as they discuss Brady’s recent trip to Austin and presentation at the Texas Association of Benefit Administrators; with a focus on employee engagement, new ideas for cost containment, and an in depth analysis of pending litigation challenging the legality of ObamaCare. Yeah… You’ll want to tune in for this one.
In this episode of Empowering Plans – Faces of Phia, Adam and Brady interview the superpowered controller of The Phia Group. From adventures in the Steel City to conquering “nice problems to have,” the team covers it all in this candid discussion.
In this can’t miss episode of Empowering Plans, Brady and Ron dissect the President’s State of the Union Address, and focus in on how it will impact those of us servicing health benefit plans – and the entire healthcare industry. This one is going to be huge.
Live from Polska – a journey around the world leads to… The Phia Group. Join Adam and Brady as they take a journey through history and across oceans, to share the story of this unsung hero.
Let’s Escargot & Meet LCARA: In this episode Ron and Brady discuss the new legal compliance and regulatory affairs team (“LCARA”) with team member Philip Qualo, and specifically address recent efforts to promote hospital transparency.
In this episode, the crew once again sit down with a valued team member, whose role sit at the crossroads between technology and healthcare. Ensuring that the privacy and security issues hounding all businesses don’t threaten The Phia Group as it leverages technology to better serve its clients, Ashley is unique not only at the company – but industrywide. Listen in to find out why, and what you need to do to get her seal of approval.
How payers, providers, and those of us who serve them, can work together as a team and achieve a winning plan for the future of healthcare. In this episode, Adam, Ron and Brady, talk about how providers – like plan sponsors – are concerned with the state of things and want to identify what’s wrong, what’s right, and how we can collaborate on a new approach that works for us all, as members of a single industry – healthcare.
Sit down, turn the volume up, and enjoy as Ron and Brady discuss with our latest Face of Phia – Hemant Dua – data, robots, and how technology is impacting healthcare, health plans, and The Phia Group’s own efforts to empower plans. Tune in, or you’ll be stuck in the stone age!
In this most recent episode, Tori Pace – another Phia superstar – shares experiences working with each department, what she’s learned from these experiences, and campaigns for a regular seat on the show.
Ron and Brady dissect the Texas decision that challenges the legality of the ACA, what is actually means, and what is next – as well as what you could (should?) be doing now.
Take a moment to meet Katie Delaney, Phia's Senior Training & Development Specialist who has been with the company since 2007. Responsible for training employees, you can thank Katie anytime a team member succeeds. Really? Listen to learn how we got to this point!
The Phia Group’s foray into higher learning! Ron discusses with professors Silverio and Jablon the forthcoming master’s degree program in plan development they will be teaching. If you’re up for the challenge, prepare to learn!
In this episode, Ron and Adam sit down with Judith McNeil. Judith is the most recent winner of our “Employee of the Quarter” award, as well as our second Face of Phia. Judith’s story goes from inspiring to hilarious, and is one you certainly won’t want to miss. Expect to see things differently by the time you’re done with this episode.
This Podcast is HUUUUGE – Brady and Ron will dig deep, analyze the recent election results, and determine how they will impact the health benefits and health care industries. Bottom line? If you listen to this episode, you will definitely impress everyone at the Thanksgiving dinner table. You’re Welcome.
In this “Partners in Empowerment” episode, Ron and Brady enjoy chatting with Michael Meloch, President of TPAC Underwriters and valued member of The Phia Group’s own advisory board. Michael isn’t shy when it comes to diagnosing the issues, boiling healthcare cost containment down to simple basics we can all appreciate, and telling it like it is. His employer based perspective and focus on the bottom line (a/k/a “risk”) is as refreshing as it is informative. Don’t miss this one!
In today’s episode, our hosts chat with Norma Phillips… our first official “Face of Phia;” (sorry Matt). Norma explains what makes her different (and special) as well as what makes The Phia Group so unique. From Friday night films, to saving the American workers’ job… Norma and the team touch all the bases.
Like it or not, healthcare is on the ballot – nationally, statewide, and locally. The questions asked and people we elect will have an impact on how we receive and pay for healthcare – and for those of us in the benefits industry – failing to identify the trends, issues, and opportunities is tantamount to waving the white flag. Stay in the know and get ready to go; don’t miss this episode of Empowering Plans.
In this episode we sit down with The Phia Group’s Marketing & Accounts Manager, Matthew Painten. Matt tells about how his time with the organization has changed him, and educated him regarding healthcare and what everyone can do to reduce their expense. Matt will give us insight into his transformation as well as how he accomplishes his work for the betterment of all.
Have you heard? In 2019 it will be easier than ever to form a self-funded “Association Health Plan” (AHPs) … So what? In the words of Jurassic Park’s Dr. Ian Malcolm (a/k/a Jeff Goldblum), we have been so preoccupied with whether or not we could, we didn’t stop to think if we should. This podcast discusses the pros and cons, as well as benefits and hurdles the final rules have created for these new AHPs. From compliance with State MEWA laws to obeying federal laws such as ERISA’s consumer protections (including the Mental Health Parity and Addiction Equity Act [MHPAEA]), we dissect why we must slow our run towards AHPs to a measured walk.
In this episode, Ron and Adam discuss the many issues, changes and challenges 2018 has lined up for 2019, and how the outcomes we witness in 2019 are certain to change everything by 2020. Tune in, or suffer the consequences!
In this episode, our hosts sit down with industry legend and innovative leader, Jerry Castelloe of Castelloe Partners, to dissect the state of the health benefits universe, identify new issues, repeat offenders, and determine what trends, risks – and victories – from the past are shaping the future.
In this episode, Ron, Brady, and Adam chat with friend and industry ally, Mark Stadler – President and CEO of BridgeHealth. As the leader of an organization whose purpose is to connect patients with the best providers – offering the highest quality care for the lowest price – regardless of geographic location, Mark and his team need to build bridges and interact with all three “Ps” of healthcare – the “P”atient, “P”ayer, and “P”rovider. This gives Mark unique insight that he now shares with our listeners.