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 NOVEMBER 2011 NEWSLETTER |
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With The Phia Group, we have recovered more money for our clients and uncovered more cases with subrogation potential than with any other vendor that we have previously used. The numbers do not lie. Your firm recovers more than the competition, leading to increased cost savings for our clients and higher customer satisfaction for us. Your company's service provides a beneficial cost containment program for our clients in these days of escalating medical expenses. The legal knowledge and technological expertise that your organization brings to the table is unmatched by any subrogation vendor.
Dave Reynolds, Capitol Administrators |
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Dear Reader,
November has been a weird month here in Boston. We enjoyed temperatures in the 60s for a number of days that outnumbered the warm days we saw last June. It's been a real change from the blizzard we fought through last month. The weather has been very strange indeed, but unlike the climate, a constant is our goal at The Phia Group to be your one source for expertise on self funding and cost containment issues.
Our newest mission is to set the industry standard for plan document language. Whether you choose to draft your plan documents in-house, use an ERISA attorney, utilize a plan document drafting service, or have us handle the entire process, our mission is to ensure that regardless of where your document comes from, your wording includes The Phia Group's unique touch. We will make sure your language not only complies with government reform, but also features innovative cost containment options that you need to better serve your clients; providing the best benefits for the lowest cost.
If your plan document doesn't feature The Phia Group's language, be sure to send us a template for a free assessment. In the meantime, have a great Thanksgiving and be sure to remember all of our troops, protecting us overseas and here at home, as you celebrate our freedom. Happy reading!
 Adam V. Russo, Esq. CEO |
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Passion for Subro Blog - What's New?
To get all the latest industry news, don't forget to visit www.passionforsubro.com. Check out the link below to see a recently posted article.
"Will the Supreme Court Carve Up Obamacare?" |
| Letter from the Editor
Well, November is here and if you are anything like me, you are excited for Thanksgiving! Another thing that I am excited about is the newest feature of The Phia Group's website that I would like to announce...
PODCASTS are HERE! The Phia Group will be posting all of our webinars to iTunes for FREE! Now you will be able to access our webinars directly from your iPhone, iPod, iPad, Mac or PC through your iTunes account. To access them now please click here.
Travel has slowed down a bit for us here at The Phia Group so we will have even more time in the office to find new and innovative ways to serve the self funded industry. We are very excited to share our ever expanding vision with all of you and heading in the new year, I hope you join us for the ride.
Have a very Happy Thanksgiving! See you next month.
Andrew Milesky
Director of Client Services |
he Phia Group Plan Language Service Center... Setting the Industry Standard
It is a fact that the greatest advantage of being self-funded is plan design. All of the plan's rights, obligations and rules are set forth in its plan document. In light of that fact, consider this... Are "Cookie Cutter Solutions" really solutions, if they do more harm than good? If there is one resonating message that I hear from administrators all over the Country, it's that "if you've met one plan, you've met one plan." No two benefit plans are the same; the same should be true for their plan documents. So why are we so eager to search for quick and easy solutions to such important matters?
One of the key benefits of self-funding is the ability, granted to the plan administrator, to draft and administer a plan document customized for their particular benefit plan population. Imagine you are a newly self funded plan. You've heard so many great things about the flexibility and customization that comes with self-funding. Indeed, a primary reason behind your decision to self-fund is your ability to control costs while producing the most robust, yet efficient plan. You aim to do this by designing your own plan-specific benefit plan document. With this in mind, you work with your third party administrator ("TPA") towards this goal, only to discover that your TPA is utilizing an online, cookie cutter "solution." Your ability to customize the document, to fit your plan's specific characteristics is limited, and at this point, you are probably not too thrilled with your first taste of self-funding.
Continued... |
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A License to Steal...
and no this is not a James Bond movie
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By Adam Russo, Esq.
Health care operates quite a bit differently than the rest of the business world and often to the beat of its own drum. As the infamous Capitol One credit card commercials exclaim, "what's in your wallet?", the only difference now is that the culprit is a hospital, waiting to relieve your plan of hard earned plan assets.
Imagine being prohibited from reviewing your credit card statement or restaurant check prior to paying your bill. Imagine if you were offered a discount, but were not allowed to review your bills for any charges that were not yours, or perhaps seemed a bit expensive. What would you do if upon entering the supermarket, you were offered a 20% discount on your entire purchase but were not allowed to review your final bill? The deal you were accepting, by its terms, would deny you the ability to ensure that none of your items were scanned twice, or that your coupons were applied. How many of you would accept the 20% discount if you were not allowed to audit this bill? I have posed this very question to audiences at various conferences across the country; approximately half of those asked said that they would accept this offer. This is the same dilemma we face in the self funded industry when it comes to dealing with preferred provider organizations (PPOs).
Continued...
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The Phia Group, LLC Announces Unique Partnership with WLT Software
Braintree, Massachusetts - November 16, 2011 - The Phia Group is proud to announce that with the completion of its extract for the purposes of data mining, it has finalized a successful partnership with WLT Software. The Phia Group has been diligently working alongside WLT to develop this tool that allows the seamless transfer of claims data based on The Phia Group's proprietary Phia System™.
Any administrator processing claims through WLT can take advantage of a quick and easy subrogation implementation with little to no IT involvement. "The WLT custom Phia extract allows our clients to save invaluable time and resources when it comes to the data transfer. The extract allows our clients to run a seamless report that will pull all of the necessary data fields Phia needs to identify potential subrogation opportunities," said Boris Senic Vice President of Claim Management at The Phia Group. WLT's CEO Tom Brooks also shared his thoughts about the partnership, "WLT Software is very excited to partner with The Phia Group and believe that their services will be of great value and a tremendous resource for our clients."
About The Phia System™
The Phia Group developed proprietary software to increase case identification by a greater rate than any other service provider, resulting in our industry leading recovery statistics.
The Phia System™ captures all recovery opportunities by thoroughly analyzing claims data. The result is an efficient process leading to faster and higher recovery totals for benefit plans. Identifying cases with true recovery opportunity is the key to optimizing savings. The Phia System™ finds cases with real value and eliminates those with no savings opportunity. The system allows us to analyze data using various logic techniques in order to project client savings and operating needs before we even open a single case.
The Phia System™ is a sophisticated application that provides step by step analysis throughout the recovery process. Key application features significantly increase efficiency and productivity, substantially enhancing recovery opportunities and maximizing savings for our clients. Each claim is analyzed utilizing up to five digit diagnosis codes, including secondary and tertiary codes.
Continued...
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Client Spotlight of the Month - Capitol Administrators
The Phia Group would like to dedicate this month's client spotlight to Capitol Administrations.
Capitol Administrators has been a Phia Group client since 2003. They boast an impressive resume providing claims administration nationwide.
About Capitol Administrators
Capitol Administrators is a third party administrator specializing in the design, building and maintenance of custom self-funded plans for our Commercial, Government, Employee Benefit Captives and Native American clients.
As it is often said about real estate, the three most important things are location, location, location; in this industry it is SERVICE, SERVICE, SERVICE! In health care planning it is critical to assure all dollars are used wisely. Capitol Administrators works with each client on an individual basis to assure all cost controls acceptable and appropriate to each client are in place in their plan. Our strategic relationship with major national carriers and our custom reporting capabilities allow Capitol to hold claim costs down without compromising the quality of care provided.
Our employees are dedicated to delivering service that leads the industry. Combine our commitmentent for exceptional service, surround it with an experienced management staff and leading edge technology, and you have CAPITOL ADMINISTRATORS.
Located in Rancho Cordova, CA, Atlanta, GA and Dallas, TX we are positioned to handle your local and national multi-state clients. We encourage you to talk with our clients about our experience and our service.
To learn more about Capitol, please visit their website at http://www.capitoladm.com/.
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Legal Case of the Month
Phia was retained to review coverage for a member who was riding a motorcycle without a helmet on private property. The member sustained in excess of $135,000 in charges associated with his catastrophic injuries. A careful review of the plan language indicated that the hazardous activity exclusion may apply but the TPA had authorized the services to be performed.
Counsel for the provider argued that the services were medically necessary and authorized in advance of being provided. The Plan, through Phia, asserted that the authorization did not guarantee coverage nor verify benefits. Over the course of a week, Phia successfully negotiated with the provider and resolved the case for no payment whatsoever.
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Consulting Case of the Month
A situation arose where a member of a self-funded plan sought treatment for certain FDA-approved drugs. The member's corresponding plan contained a provision which excluded drugs if they considered experimental and investigational. The plan also had stop loss coverage which mirrored the plan's provisions (including the experimental and investigational exclusion).
In this case, the drugs - when offered individually were FDA-approved, however, the specific combination offering of the drugs has yet to be FDA-approved. The plan language only provided that "non-FDA approved" drugs would be considered experimental and investigational. The question arose as to whether the treatment of offering both drugs would be experimental and investigational.
The plan language did allow for the plan administrator to use discretionary authority to interpret the terms and conditions of the plan language. However, the plan administrator (and plan) sought medical opinions from the member's case manager and other reviewing physicians regarding the treatments.
Upon review and evaluation of the situation, the member sought another type of treatment which presented no questions as to whether it would be considered experimental and investigational. This assured no issues with stop loss reimbursement and that the member's claims for his treatment would be covered under the plan. |
Department of the Month - Phia Group Consulting ("PGC") - Plan Document Services The Phia Group's attorneys are at the forefront of the developing health benefits industry as demonstrated by our innovative plan provisions. Our attorneys are actively pursued to lecture at conferences, write articles for various industry publications, and participate in the legislative process in the regard. To promote efforts and improve the health benefits industry, our attorneys publish a leading industry blog and promote education for all involved in the drafting and implementation of benefit plans. Our belief that strong plan language is critical to the success of a self funded plan is reflected in every plan we touch. Continued... |
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Spotlight Employee of the Month - Christina Farrington
 Christina has been an employee of The Phia Group since January 2010. She was hired to be a part of our Case Evaluation Department. Since being hired, Christina joined The Phia Group Consulting team as a Legal Coordinator. Most recently, Christina was promoted to Manager of Plan Drafting for her hard work and dedication.
Christina received her paralegal certificate from Massasoit Community College in 2010.
Christina lives locally and enjoys spending time with her husband and two daughters Caitlin and Courtney. In her spare time, Christina enjoys playing pool, being a member of her daughter Caitlin's school parent/teacher association and volunteering for various fundraising activities and events.
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Upcoming Webinars!
December Webinar
"A View from the Other Side - The Provider Perspective - Maximizing your Negotiations"
December 14th 1-2PM EST January Webinar "The Industry Standard for Plan Language: The Phia Group's Plan Language Service Center is Setting the Standard for Plan Language!" Registration coming soon! To view all past webinars click here. |
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Where in the World is Phia?
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Presentations
 To view The Phia Group's past presentations please click here. . |
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©2000-2011, The Phia Group, LLC | 163 Bay State Drive Braintree, MA 02184 | Phone: 781-535-5600 | Fax: 781-535-5656 | |
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