The Phia Group's Podcast

Episode 281: Empowering Plans: P242 – Surprises and The No Surprises Act

The Phia Group — Fri, 08 May 2026 12:41:18 +0000

Join attorneys Cindy Merrell and Bryan Dunton as they take a deep dive into real-world cases involving the No Surprises Act. Cindy and Bryan break down how the Act is being applied, highlight common issues and pitfalls, and discuss what these cases mean for payors, providers, and other stakeholders navigating these billing disputes.

Episode 280: Empowering Plans: P241 – Headlines and Finish Lines – Phia’s Derby Preview

The Phia Group — Thu, 30 Apr 2026 18:41:44 +0000

It is time again for the fastest 20 minutes in podcasting as Cindy Merrell and Corey Crigger take over the Empowering Plans podcast to preview The Kentucky Derby. Don’t worry, this podcast isn’t solely about horse racing! Cindy and Corey also discuss two big news items that affect the healthcare industry – litigation surrounding Roundup and a major article in the New York Times about the No Surprises Act. Don’t be left in the dust. Tune in to hear their insights into healthcare and horse racing prognostication!

Episode 279: Empowering Plans: P240 – Tobacco Surcharge Litigation Is Hitting a New Level

The Phia Group — Wed, 08 Apr 2026 18:53:37 +0000

As a follow-up to this past January’s podcast episode on tobacco surcharges, new litigation has been filing and this time, it’s on a much larger scale. Humana is facing a class-action lawsuit, filed on March 17, 2026, alleging violations of the wellness program rules and fiduciary duties related to tobacco surcharge as part of a wellness program. Join attorneys Kelly Dempsey and Naga Vivekanandan as they compare this new suit to prior cases, and explain why this is different and what it could mean for future ligation and plans’ continuing struggles to comply with wellness program rules.

Episode 278: Empowering Plans: P239 – The ACIP Case and What it Means for Health Plans

The Phia Group — Thu, 26 Mar 2026 14:00:22 +0000

On this week’s Empowering Plans Podcast, Attorneys Jen McCormick and Nick Bonds talk through a federal district court case out of Massachusetts that has put a preliminary pause on vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP) – and why the case has broader potential implications than it may initially appear. They break down what happened, why the court intervened, and what this means for self-funded health plans’ obligations under the ACA’s preventive care mandate.

Episode 277: Empowering Plans: P238 – Hot Topics and Spitting Fire with Ron E. Peck

The Phia Group — Thu, 12 Mar 2026 18:03:35 +0000

On this episode of the Empowering Plans podcast, attorney Ron Peck engages in a one-on-one discussion with YOU, regarding two of the “hottest” topics being discussed on the road. Don’t be left out; tune in now!

Episode 276: Empowering Plans: P237 – Where is the NSA at Today?

The Phia Group — Wed, 25 Feb 2026 21:11:48 +0000

On today’s episode of the Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson discuss the current state of the No Surprises Act (NSA) and the Independent Dispute Resolution (IDR) process. From difficulties managing dispute volume to current litigation and legislative proposals, this episode provides key insight into changes to and challenges with the IDR process.

Episode 275: Empowering Plans: P236 – Dangers of Legacy Language

The Phia Group — Thu, 12 Feb 2026 16:17:08 +0000

In this installment of The Phia Group’s “Empowering Plans” podcast, attorneys Bryan Dunton and Cindy Merrell discuss what happens when laws evolve faster than contracts, and how many compliance failures live in old documents. This episode breaks down how legacy contract language creates modern risk under HIPAA Part 2 and emerging PBM transparency reforms, particularly where downstream data sharing and compensation disclosures are involved. Brokers, TPAs, and plan fiduciaries will want to tune in and find out how these changes will impact their groups.

Episode 274: Empowering Plans: P235 – The Latest No Surprises Act Developments: A 2026 Reality Check for TPAs

The Phia Group — Thu, 29 Jan 2026 20:01:04 +0000

In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O’Hara share the latest information TPAs and employer plan sponsors need to know about the No Surprises Act. The discussion focuses on recent federal guidance, updated arbitration data, key court decisions affecting NSA enforcement, and practical takeaways for managing provider billing disputes and controlling plan exposure in 2026.

Episode 273: Empowering Plans: P234 – Smoking Hot Litigation: When Tobacco Surcharges Go Up In Flames

The Phia Group — Fri, 16 Jan 2026 19:34:26 +0000

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.

Episode 272: Empowering Plans: P233 – The Butterfly Effect of Healthcare Costs

The Phia Group — Tue, 16 Dec 2025 22:05:10 +0000

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.”

Episode 271: Empowering Plans: P232 – Get Psyched: Innovative Therapies on the Rise

The Phia Group — Fri, 05 Dec 2025 14:18:27 +0000

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.

Episode 270: Empowering Plans: P231 – Are EHBs Really That “Essential”?

The Phia Group — Thu, 20 Nov 2025 22:37:09 +0000

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.

Episode 269: Empowering Plans: P230 – What Happens When Subrogation and the NSA Collide?

The Phia Group — Thu, 06 Nov 2025 18:08:01 +0000

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.

Episode 268: Empowering Plans: P229 – From Free to Fee: The New Rules for COVID Vaccines and Testing"

The Phia Group — Thu, 09 Oct 2025 16:05:36 +0000

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.

Episode 267: Empowering Plans: P228 – Prior Authorization – The Promise and the Peril

The Phia Group — Thu, 25 Sep 2025 19:52:48 +0000

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.

Episode 266: Empowering Plans: P227 – Method to the Badness

The Phia Group — Fri, 12 Sep 2025 13:02:37 +0000

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!

Episode 265: Empowering Plans: P226 – RBP Meets NSA: Clearing Up the Confusion

The Phia Group — Thu, 28 Aug 2025 17:11:40 +0000

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.

Episode 264: Empowering Plans: P225 – Adverse Claims & Prior Authorizations: Big Changes Ahead

The Phia Group — Thu, 14 Aug 2025 19:37:06 +0000

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.

Episode 263: Empowering Plans: P224 – CMS Spotlight: Cleaning Up Provider Data and Fixing IDR Errors

The Phia Group — Thu, 31 Jul 2025 16:59:27 +0000

In this episode, we take a closer look at two key developments out of CMS that could reshape how provider data and dispute resolution work in practice. First, we explore the agency’s proposed National Provider Directory — an ambitious effort to clean up fragmented provider data and reduce ghost networks. Then, we break down insights from the July 2025 CMS Technical Assistance Seminar, which tackled the growing problem of errors in the Federal Independent Dispute Resolution (IDR) process — from procedural missteps to jurisdictional mistakes and default determinations on ineligible claims. What’s CMS doing to fix the system — and what gaps are still leaving plans vulnerable?

Episode 262: Empowering Plans: P223 – Telemedicine, DPCs, and the Future of HSA-Compatible Plans under The One, Big, Beautiful Bill

The Phia Group — Thu, 17 Jul 2025 12:49:36 +0000

Today, attorneys Kelly Dempsey and Naga Vivekanandan dive into the latest landmark healthcare-related legislation, nicknamed “The One, Big, Beautiful Bill," and how it will reshape High-Deductible Health Plans (HDHPs), telemedicine, and Direct Primary Care (DPC) arrangements. They explore the IRS rules, what's changed, and what it means for employers, employees, and plan administrators.

Episode 261: Empowering Plans: P222 – SCOTUS Shockwaves: Analysis of June Decisions for Self-Funded Plans

The Phia Group — Tue, 01 Jul 2025 13:43:33 +0000

In this episode of Phia’s Empowering Plans Podcast, attorneys Nicholas Bonds, Esq. and Bryan M. Dunton, Esq., break down the key Supreme Court rulings issued in June 2025 that have direct implications for self-funded group health plans and their fiduciaries. From decisions impacting coverage mandates, nationwide injunctions, and gender-affirming care, Nick and Bryan explore how these opinions reshape the regulatory landscape and discuss practical takeaways for plan administrators and TPAs. Whether you’re updating plan language or keeping an eye out for compliance risks, this is an episode you can’t afford to skip.

Episode 260: Empowering Plans: P221 – Saying What You’re Thinking

The Phia Group — Fri, 20 Jun 2025 14:24:32 +0000

Join The Phia Group’s Corey Crigger and Ron Peck as they discuss some of the things many in our industry seem to be thinking, but are often afraid to say aloud. Does being a good fiduciary mean being a bad guy? Tune in and find out.

Episode 259: Empowering Plans: P220 – Algorithms and Adjudication: How AI Is Affecting the Self-Funded Industry

The Phia Group — Fri, 06 Jun 2025 12:11:55 +0000

On the latest installment of the Empowering Plans podcast series, join attorneys Jon Jablon and Kendall Jackson as they discuss the integration of AI into the self-funded industry. From HIPAA considerations to current case law, this episode explores the impact of AI on health plans and TPAs thus far. It is an episode you can’t afford to miss!

Episode 258: Empowering Plans: P219 – Executive Orders, Tariffs, and a Crystal Ball

The Phia Group — Wed, 21 May 2025 16:13:26 +0000

Join attorneys Bryan Dunton and Cindy Merrell as they explore President Trump’s latest moves to address the rising cost of prescription drugs. Cindy and Bryan discuss potential impacts of recent Executive Orders and proposed tariffs.

Episode 257: Empowering Plans: P218 – Unreasonable Plan Fees on Trial: Cunningham v. Cornell University

The Phia Group — Thu, 08 May 2025 15:38:29 +0000

In this episode, we unpack the Supreme Court’s unanimous decision in Cunningham v. Cornell University — a landmark ERISA case with major implications for retirement and health plan fiduciaries. We explain the facts behind the case, what “prohibited transactions” really mean, and why the Court's ruling on affirmative defenses matters. If your health plan pays fees to TPAs, PBMs, IDR vendors, or brokers, this episode is for you.

Episode 256: Empowering Plans: P217 – The Most Exciting Two Minutes in Cost Containment

The Phia Group — Fri, 02 May 2025 13:06:45 +0000

The Run for the Roses is here! Join two of Phia’s Louisville, Kentucky, employees, Corey Crigger and Cindy Merrell, as they discuss the event that takes over their city once a year! Coming on the heels of a historic weather event, Corey and Cindy discuss all things Derby. From Cindy’s experience at Dawn at the Downs to predictions for winners, this podcast has it all. Don’t be fooled, this podcast isn’t just about horse racing. Corey and Cindy also discuss pitfalls of AI use in the legal world. Can attorneys depend on AI for their legal research? Meanwhile, which horse has the best chance to win the Derby? Can Corey hit the trifecta for the second year in a row? Tune in to the Empowering Plans Podcast for these answers and many more!

Episode 255: Empowering Plans: P216 – Why 2025 is the Year to Go Self-Funded

The Phia Group — Thu, 24 Apr 2025 17:16:21 +0000

Our consulting team has received numerous questions in Q1 2025 about employers considering self-funding their health plans. Join Attorneys Jennifer McCormick and Kelly Dempsey as they go through what the driving factors are behind employers considering self-funding, the pros and cons of self-funding, and some of the major differences employers will encounter. If you’re considering taking the leap, take a listen first!

Episode 254: Empowering Plans: P215 – Plan Sponsor Discretion Advised

The Phia Group — Fri, 11 Apr 2025 12:31:21 +0000

ERISA gives plan sponsors great power and great responsibility. On this week’s podcast, attorneys Ron Peck and Nick Bonds get back to ERISA fundamentals to talk about how to really embrace fiduciary status and properly exercise discretionary authority.

Episode 253: Empowering Plans: P214 – Unpacking Weight Loss Drugs

The Phia Group — Fri, 28 Mar 2025 12:21:50 +0000

On this episode of the Empowering Plans podcast, attorneys Corey Crigger and Kendall Jackson discuss the hot button topic of weight loss drugs. Tune in to learn more about the latest advances in this space and the various coverage and exclusion options plans may pursue.

Episode 252: Empowering Plans: P213 – Error 304: Good Faith Negotiation Not Found

The Phia Group — Fri, 14 Mar 2025 15:39:49 +0000

Artificial intelligence may be changing the trajectory of the self-funded industry – but can it negotiate? In this episode of The Phia Group’s Empowering Plans podcast, attorneys Brian O’Hara and Jon Jablon break down real-life examples of AI-driven responses in the No Surprises Act’s Open Negotiations process that range from nonsensical to outright misleading, where negotiating with AI is like trying to haggle with a toaster. From missing claim numbers to automated counteroffers that make no sense, Brian and Jon discuss whether AI is making negotiations easier, or defeating the purpose of the statutory process to begin with. Tune in for an honest discussion of the pitfalls of AI in No Surprises Act negotiations.

Episode 251: Empowering Plans: P212 – Lewandowski v. Johnson & Johnson – Big win or warning?

The Phia Group — Fri, 28 Feb 2025 13:11:07 +0000

On this episode of the Empowering Plans Podcast, attorneys Brady Bizzaro and Cindy Merrell delve into the details of the Lewandowski v. Johnson & Johnson case. Is this case a big win for plan fiduciaries or a warning?

Episode 250: Empowering Plans: P211 – Network Adequacy Under MHPAEA

The Phia Group — Fri, 14 Feb 2025 14:06:40 +0000

Attorneys Kelly Dempsey and Bryan Dunton dive into the results of the 2024 MHPAEA Report to Congress. The EBSA and CMS have continued to improve their focus on network design and adequacy for group health plans. In this episode, Kelly and Bryan discuss how these parity problems manifest themselves in testing and what plans can do to resolve them.

Episode 249: Empowering Plans: P210 – Mental Health Parity: New Year, New Rules, New Lawsuits

The Phia Group — Fri, 31 Jan 2025 14:24:36 +0000

Attorneys Jen McCormick and Nick Bonds ring in the Lunar New Year by breaking down the ERIC v. HHS lawsuit in which an industry advocate challenged the federal regulators’ new Final Rules enforcing the MHPAEA and mental health parity rules. Could this case blaze a new path for challenging agency actions in a post-Chevron Doctrine world? Join us as we discuss the potential implications for group health plans.

Episode 248: Empowering Plans: P209 – 2025 Healthcare Hot Takes

The Phia Group — Fri, 17 Jan 2025 14:41:24 +0000

It’s a new year, and a new type of Empowering Plans podcast! In a world full of talking heads and 2-minute news cycles, hot takes have become the norm. This is true from mainstream news media to sports talk radio. Ron Peck and Corey Crigger throw their hat in the hot take ring by speculating on what some of the biggest news stories could be in 2025. From AI to RFK Jr, join Ron and Corey as they gaze into the crystal ball and make their bold predictions of what we will be talking about all year.

Episode 247: Empowering Plans: P208 – The Evolution of the Birth Control Benefits Mandate

The Phia Group — Thu, 02 Jan 2025 20:36:40 +0000

On today’s episode of the Empowering Plans podcast series, attorneys Kendall Jackson and Brian O’Hara discuss the Biden administration’s decision to withdraw proposed rules that would have expanded the birth control benefits mandate. Join us in our discussion of the mandate and how it has evolved throughout the Obama, Trump, and Biden administrations.

Episode 246: Empowering Plans: P207 – Denied Claims Beyond the Headlines

The Phia Group — Fri, 20 Dec 2024 14:02:17 +0000

On this episode of the Empowering Plans podcast series, attorneys Corey Crigger and Cindy Merrell discuss the murder of UnitedHealthcare’s CEO, which fueled public outcry over denied claims.

Episode 245: Empowering Plans: P206 – Non-Preferred Carrier Fees: Incentives or Control?

The Phia Group — Thu, 05 Dec 2024 21:30:47 +0000

In this episode of the Empowering Plans podcast, attorneys Jon Jablon and Brady Bizarro delve into the details of a recent lawsuit where BCBS of Michigan, in its capacity as a TPA, is alleged to have engaged in anticompetitive practices for charging a fee to a group that chose a stop-loss carrier other than BCBS. This case is in its infancy as of December 2024, but we expect it to have noticeable effects on the stop-loss marketplace regardless of outcome. In this episode, Jon and Brady discuss those potential effects and how a holding either way could impact self-funding as a whole.

Episode 244: Empowering Plans: P205 – Lessons From a Florida IDR Case

The Phia Group — Tue, 05 Nov 2024 13:04:55 +0000

On this episode of the Empowering Plans Podcast, attorneys Ron Peck and Nick Bonds talk through a recent Florida case addressing judicial review of IDR determinations and highlight some of the key insights and takeaways for any entity subject to the No Surprises Act.

Episode 243: Empowering Plans: P204 – Nightmares on Self-Funded Street

The Phia Group — Fri, 25 Oct 2024 13:05:15 +0000

Join Attorneys Corey Crigger and Kendall Jackson on this Halloween edition of the Empowering Plans Podcast. Corey and Kendall take a look at topics that send shivers down the spine of the self-funded industry. How do you protect your plan from the scary cost of gene therapies? What will the rapidly advancing AI sector mean for you and your clients? What is the best trick or treat candy? Tune in to find the answers to these questions and many more on the Empowering Plans Podcast.

Episode 242: Empowering Plans: P203 – Gender-Affirming Care, Is it Covered?

The Phia Group — Tue, 15 Oct 2024 13:39:03 +0000

On this episode of the Empowering Plans Podcast, attorneys Jon Jablon and Cindy Merrell explore the changing landscape of several state and federal laws that affect coverage of gender-affirming care.

Episode 241: Empowering Plans: P202 – Senator Sanders: “Stop ripping us off.”

The Phia Group — Fri, 27 Sep 2024 13:08:54 +0000

Attorneys Brady Bizarro and Andrew Silverio discuss today’s senate committee hearing on GLP-1 drug pricing and strategies that self-funded employers are using to manage the extreme costs of these drugs while we wait and hope for congressional action.

Episode 240: Empowering Plans: P201 – Diving Into the Parity Pool: MHPAEA’s Latest Updates

The Phia Group — Fri, 13 Sep 2024 13:00:46 +0000

Regulators finally announced the long-awaited MHPAEA Final Rules on September 9, 2024. Many of these changes will directly affect group health plan design and modify the NQTL comparative analysis testing requirements - many of which will be significant for plans as they prepare for 2025. Join attorneys Jennifer McCormick and Bryan Dunton for their discussion on several critical considerations for plans as renewal season approaches.

Episode 239: Empowering Plans: P200 – Recognizing Our Blind Spots

The Phia Group — Fri, 06 Sep 2024 12:30:37 +0000

Dr. Marty Makary is a New York Times bestselling author, renowned Johns Hopkins surgeon, and globally recognized expert on medical research. In its most recent edition of the Empowering Plans podcast series (“Recognizing Our Blind Spots”), Dr. Makary was a special guest as he engaged in conversation with CEO Adam V. Russo about his new book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health, https://geni.us/blindspots. This is an episode jampacked with enlightening and engaging anecdotes that will leave you with new insight into commonly held assumptions about healthcare. After all, in order to fix the healthcare industry, people need to have access to correct information about modern medicine.

Episode 238: Empowering Plans: P199 – Summer Regulation Rundown

The Phia Group — Fri, 30 Aug 2024 13:14:52 +0000

The regulators rush to finalize a suite of marquee regulations as the clock gradually runs out on the Biden administration. Even when finalized, these regulations may be vulnerable in the post-Chevron landscape. Attorneys Kelly Dempsey and Nick Bonds pick apart some of the big rules we’re looking forward to and the challenges they may face.

Episode 237: Empowering Plans: P198 – Healthcare on the Ballot

The Phia Group — Fri, 16 Aug 2024 12:34:01 +0000

Nick Bonds and Corey Crigger are hosting this political edition of the Empowering Plans Podcast series. With an election looming in November, Nick and Corey take a look at the policies and agendas from the Harris/Walz and Trump/Vance tickets. They discuss the impact that each administration could have on the self-funded industry and the country, in the most civil political discourse you can find. Tune in to hear what each nominee has to say about: Medical Debt, the Opioid Crisis, Public Healthcare options, and more!

Episode 236: Empowering Plans: P197 – The Concerns About PBMs and the Demand for Reform

The Phia Group — Fri, 02 Aug 2024 16:27:37 +0000

In this episode of the Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson break down the consequences of PBM steerage. Join us in the discussion of the Federal Trade Commission’s inquiry into PBM practices and the push for legislation to increase transparency in the market and hold PBMs accountable.

Episode 235: Empowering Plans: P196 – Exploring Claims Processing Models

The Phia Group — Fri, 19 Jul 2024 14:11:59 +0000

On this episode of the Empowering Plans Podcast, attorneys Andrew Silverio and Cindy Merrell delve into the pros and cons of the pay and chase versus pend and pay models of claims processing. They provide an in-depth discussion on the coordination of benefits and the timing of claims processing when another party may be responsible for payment.

Episode 234: Empowering Plans: P195 – SCOTUS Decisions: Harrington and Loper's Impact on Healthcare

The Phia Group — Wed, 03 Jul 2024 14:35:15 +0000

In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Corey Crigger break down two of the most significant Supreme Court cases just decided this term – the Harrington case (rejecting the largest opioid settlement in the country) and the Loper case (in which the Supreme Court ended Chevron deference). How will these cases impact the healthcare landscape? What should self-funded plans and their partners know moving forward? Tune in to hear our expert analysis.

Episode 233: Empowering Plans: P194 – The Rapid Evolution of the Pregnant Workers Fairness Act

The Phia Group — Fri, 21 Jun 2024 13:54:55 +0000

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 have reached opposite conclusions and, of course, what this all means for self-funded health plans. It’s hard to keep up as this one went from crawling to running in fewer than two months!

Episode 232: Empowering Plans: P193 – Stopping Esophageal Cancer In Its Tracks

The Phia Group — Fri, 07 Jun 2024 12:34:53 +0000

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 of EsoGuard, however, plans can identify which participants are at risk, and have them tested quickly, non-invasively, and inexpensively. You can save lives and money… but you cannot afford to miss this episode. For those interested in learning more about EsoGuard, please contact Jim Fricchione, Vice President – Employer Markets with Lucid Diagnostics, at 617-921-7949 or JMF@LucidDX.com.

Episode 231: Empowering Plans: P192 – Places, Promises, and Plan Documents

The Phia Group — Thu, 23 May 2024 18:40:02 +0000

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 security blanket of federal law flew right out the window! Tune in for the full details, and advice on how to not let this happen to you!

Episode 230: Empowering Plans: P191 – Derby Reflections and Gambles on Healthcare Strategies (Part 2)

The Phia Group — Wed, 15 May 2024 12:23:21 +0000

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 impact of this move on rural markets and what it signifies for the industry's future.

Episode 229: Empowering Plans: P190 – Derby Insights and Gambles on Healthcare Strategies (Part 1)

The Phia Group — Fri, 10 May 2024 12:21:52 +0000

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 our clients. Packed with valuable information, we had to split the discussion into two parts!

Episode 228: Empowering Plans: P189 – SCOTUS Showdowns and Derby Delights

The Phia Group — Fri, 03 May 2024 12:03:06 +0000

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 implications of presidential immunity as well as the role EMTALA can play in state regulations. No other podcast in the country will break down SCOTUS cases and Derby winners like the Empowering Plans Podcast!

Episode 227: Empowering Plans: P188 – Fiduciary Duties in the Spotlight – Lewandowski v. Johnson and Johnson

The Phia Group — Fri, 26 Apr 2024 12:24:28 +0000

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 wins, this case highlights the importance of ERISA’s fiduciary duties and the gravity of the decisions fiduciaries are (or should be) making.

Episode 226: Empowering Plans: P187 – Decoding ACA FAQ #66: Essential Health Benefits Unpacked

The Phia Group — Fri, 12 Apr 2024 12:29:15 +0000

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 and analysis of FAQ #66.

Episode 225: Empowering Plans: P186 – Xenotransplantation: A Potential Game Changer for Self-Funded Plans

The Phia Group — Fri, 29 Mar 2024 12:33:06 +0000

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 language, and stop loss provisions. Tune in to gain invaluable insights into the intersection of law, healthcare, and cutting-edge medical advancements.

Episode 224: Empowering Plans: P185 – Weighing the Options

The Phia Group — Fri, 15 Mar 2024 12:17:50 +0000

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 demand has had on health plans and consumers. Are health plans and consumers informed about the benefits and drawbacks of this drug? Are consumers too focused on the benefits? Are health plans too focused on cost? Find out as Ron and Corey discuss one of the hottest topics in the industry.

Episode 223: Empowering Plans: P184 – State of the Union, 2024

The Phia Group — Fri, 08 Mar 2024 18:09:22 +0000

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 close eye on in the coming months. Attorney’s Brady Bizarro and Nick Bonds bring you some of the highlights in this episode of the Empowering Plans podcast.

Episode 222: Empowering Plans: P183 – The Therapeutic Equivalence Approach: A New “Pill”ar of Contraceptive Coverage

The Phia Group — Fri, 01 Mar 2024 13:17:33 +0000

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 guidance issued in 2022… or don’t! The DOL introduced the “therapeutic equivalence” approach, whereby plans can comply with the law in a different, potentially less-burdensome way. Join The Phia Group’s Kendall Jackson and Jon Jablon as they discuss this “therapeutic equivalence” approach to compliance, what it means for consumers, and what it means for health plans.

Episode 221: Empowering Plans: P182 – Navigating Post-Settlement Fund Pursuits

The Phia Group — Fri, 16 Feb 2024 13:26:40 +0000

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?

Episode 220: Empowering Plans: P181 – Chevron Deference in Peril – What It Could Mean for Healthcare Regulations

The Phia Group — Fri, 02 Feb 2024 13:30:08 +0000

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 summer, you do not want to miss our take on how the NSA, the Medicare drug price negotiations, and the ACA itself could be at stake.

Episode 219: Empowering Plans: P180 – The Continuing Evolution of MHPAEA

The Phia Group — Fri, 19 Jan 2024 15:43:45 +0000

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 regulations and insights we have received from regulating bodies through the NQTL Comparative Analysis Process. In addition to highlighting the significance of how these issues should be addressed within an employer’s PD/SPD, there are three main changes discussed to create visibility for employers creating new 2024 PD/SPDs.

Episode 218: Empowering Plans: P179 – Higher Healthcare Prices (Made From Concentrate)

The Phia Group — Fri, 05 Jan 2024 13:43:34 +0000

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 patients caught in the middle, Ron and Nick outline just a few of their concerns and discuss some of the tools health plans have at their disposal.

Episode 217: Empowering Plans: P178 – Back to December (Phia’s Version)

The Phia Group — Thu, 21 Dec 2023 20:35:15 +0000

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 Stay Stay tuned into this podcast episode. In addition to the big changes in 2023, we look forward to 2024 and ask, are you … Ready For It?

Episode 216: Empowering Plans: P177 – Entering the Danger Zone: Cross-Plan Offsetting

The Phia Group — Fri, 08 Dec 2023 14:48:37 +0000

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?

Episode 215: Empowering Plans: P176 – Copay Accumulator Programs Take a Hit: What’s Next?

The Phia Group — Wed, 22 Nov 2023 14:47:27 +0000

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 latest rule being struck down, where does the law stand now and what will happen next?

Episode 214: Empowering Plans: P175 – No Surprises Act Brings More Surprises & Other Surprises for 2024

The Phia Group — Thu, 09 Nov 2023 13:16:53 +0000

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 couple other items for 2024 that might have fallen off the radar, including COVID-19 tolling requirements. (COVID may be over but the impact on certain items could extend well into 2024…).

Episode 213: Empowering Plans: P174 – PCORI and Parity and Lawsuits, Oh My!

The Phia Group — Fri, 27 Oct 2023 12:51:19 +0000

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 that may have significant implications for ERISA plans going forward. But don’t be scared, Phia is here to help!

Episode 212: Empowering Plans: P173 – Gene-y in a Bottle: A Magical Overview of Cell and Gene Therapy

The Phia Group — Fri, 13 Oct 2023 13:02:45 +0000

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 the concerns they are hearing from clients. You don’t know what we can see, so join us on a magic carpet ride around this life saving, but costly treatment.

Episode 211: Empowering Plans: P172 – Navigating the Gag Clause Prohibition

The Phia Group — Fri, 29 Sep 2023 14:03:26 +0000

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 to be done, how to do it, and how to keep yourself safe and compliant.

Episode 210: Empowering Plans: P171 – Mass Torts 101

The Phia Group — Fri, 15 Sep 2023 12:41:38 +0000

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 and multidistrict litigation (MDL) – while delving into a couple of the larger MDLs making news of late.

Episode 209: Empowering Plans: P170 – PSA on the NSA

The Phia Group — Fri, 01 Sep 2023 11:32:15 +0000

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 highlighting the benefits of the Safeguard Program. Just Say No to skipping this episode of Empowering Plans.

Episode 208: Empowering Plans: P169 – Let’s Keep Learning - Back to (Law) School

The Phia Group — Fri, 18 Aug 2023 13:27:36 +0000

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!

Episode 207: Empowering Plans: P168 – “Drafting” Plan Exclusions

The Phia Group — Fri, 04 Aug 2023 13:08:06 +0000

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!

Episode 206: Empowering Plans: P167 – Who is a Fiduciary and Does it Even Matter? Lawsuits Abound!

The Phia Group — Fri, 21 Jul 2023 12:52:16 +0000

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!

Episode 205: Empowering Plans: P166 – Delving Into Dobbs, One Year In

The Phia Group — Fri, 07 Jul 2023 16:22:11 +0000

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.

Episode 204: Empowering Plans: P165 – Artificial Intelligence Meets Subrogation

The Phia Group — Mon, 26 Jun 2023 16:38:10 +0000

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 the larger context of healthcare law.

Episode 203: Empowering Plans: P164 – The Key to a Successful Self-funding Experience: Knowledge!

The Phia Group — Fri, 09 Jun 2023 13:16:35 +0000

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.

Episode 202: Empowering Plans: P163 – ChatGPT: Disrupting the Healthcare Industry

The Phia Group — Fri, 19 May 2023 12:34:11 +0000

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 care. What are the advantages of using AI in this manner? What are the concerns? Tune in for what will be a topic that we revisit in the coming weeks and months!

Episode 201: Empowering Plans: P162 – Mind the Gap 2.0: Don’t be Afraid to Ask for a Handbook

The Phia Group — Fri, 12 May 2023 14:26:51 +0000

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!

Episode 200: Empowering Plans: P161 – New Challenges to Old Favorites - NSA, ACA, and more (Acronyms)!

The Phia Group — Fri, 28 Apr 2023 12:56:56 +0000

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? Tune in to find out!

Episode 199: Empowering Plans: P160 – How the Ending of COVID-era National Emergency Impacts Your Health Plan

The Phia Group — Tue, 18 Apr 2023 19:26:43 +0000

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 health plans from coast to coast are scrambling to decide whether they must adjust their processes.

In the latest Empowering Plan Podcast, Attorney Jennifer McCormick, Senior Vice President, Consulting, and Joanie Verinder, Director, Service Strategist, discuss the sudden end to the National Emergency, the many ways in which health benefit plans are affected, particularly in regards to timelines, and the information their respective participants need to be aware of.

Episode 198: Empowering Plans: P159 – Putting the Patient First: Challenges to Common TPA Operations

The Phia Group — Fri, 31 Mar 2023 12:59:16 +0000

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 applicable law places certain limits on all of them that are not always so intuitive. Tune in as Jon and Katie discuss some best (and worst) practices, and examine critical issues facing TPAs and health plans in today's self-funded industry.

Episode 197: Empowering Plans: P158 – Seek and Ye Shall Find

The Phia Group — Fri, 17 Mar 2023 13:37:45 +0000

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 heightened need to capitalize on opportunities for plans to recover funds. Don’t miss Phia’s veteran subrogation attorneys weighing in on how healthcare plans can be reimbursed so that their participants reap long-term benefits.

Episode 196: Empowering Plans: P157 – New TPA Liabilities – Section 1557

The Phia Group — Fri, 03 Mar 2023 13:53:47 +0000

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 of which we see regularly used by TPAs, the court rejected them all, potentially expanding the scope of Section 1557. Tune in to hear more about this significant case and what it means for our industry.

Episode 195: Empowering Plans: P156 – Accommodating Reasonably: Navigating the ADA and PWFA in 2023

The Phia Group — Fri, 17 Feb 2023 13:54:29 +0000

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 related medical conditions. Tune in to learn why this is important for employers in 2023 and beyond!

Episode 194: Empowering Plans: P155 – The State of the Union 2023: Phia’s Take

The Phia Group — Fri, 10 Feb 2023 14:39:55 +0000

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 the president’s speech, providing you with their reaction and analysis, and explain what you should be watching this year.

Episode 193: Empowering Plans: P154 – No Ordinary Time in Healthcare

The Phia Group — Fri, 03 Feb 2023 15:24:44 +0000

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 are here to keep you up to date on the ever-changing world of healthcare.

Episode 192: Empowering Plans: P153 – Living Up To Expectations

The Phia Group — Fri, 20 Jan 2023 14:41:28 +0000

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!

Episode 191: Empowering Plans: P152 – The Contemporary Fiduciary: Emerging Law on an Old Topic

The Phia Group — Fri, 06 Jan 2023 13:56:35 +0000

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 winds are once again changing to challenge certain long-held understandings about fiduciary duties. TPAs in particular should tune into this one!

Episode 190: Empowering Plans: P151 – The Who, What, and When of Offsetting Benefits

The Phia Group — Tue, 20 Dec 2022 19:31:56 +0000

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.

Episode 189: Empowering Plans: P150 – Manufacturer Assistance Programs

The Phia Group — Fri, 09 Dec 2022 13:45:05 +0000

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.

Episode 188: Empowering Plans: P149 – Another Ping-Ponging of IC/EE Rules?

The Phia Group — Thu, 17 Nov 2022 17:07:07 +0000

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.

Episode 187: Empowering Plans: P148 – The Ever Changing Times of Healthcare

The Phia Group — Fri, 04 Nov 2022 12:50:53 +0000

“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.

Episode 186: Empowering Plans: P147 – Transparency & More: Burning CAA/NSA FAQs

The Phia Group — Fri, 28 Oct 2022 13:07:58 +0000

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.

Episode 185: Book of Russo: Chapter 5

The Phia Group — Fri, 21 Oct 2022 13:18:06 +0000

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.

Episode 184: Empowering Plans: P146 - A Possible Threat to a Plan’s Discretionary Authority

The Phia Group — Fri, 14 Oct 2022 13:17:20 +0000

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!

Episode 183: Empowering Plans: P145 - Conflicting Views on COVID: Is the Pandemic “Over”

The Phia Group — Fri, 30 Sep 2022 13:21:36 +0000

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.

Episode 182: Book of Russo: Chapter 4

The Phia Group — Thu, 22 Sep 2022 14:40:58 +0000

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.