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 DECEMBER 2011 |
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"Through our partnership with The Phia Group, our clients will continue to benefit from customized Plan Documents, but will also have the added assurance of Plans written by attorneys with the most recent industry and compliant considerations, delivered in a more timely fashion."
-Kathy Enochs, COO
GPA |
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2011 marks the 3rd consecutive year The Phia Group has been included in Inc. Magazine's list of top growing companies |
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 | The Phia Group Christmas Party 2012 - From Left: Andrew Milesky, Mike Branco, Adam Russo | |
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Dear Reader,
What a year this has been! At this time last year, we were hoping that 2011 would clarify the picture for all of us when it comes to health care reform. Unfortunately, as this year comes to a close, we can see that 2011 just brought more questions than answers.
I hope that my staff here at The Phia Group was able to assist you and will continue to assist you with the increasing number of issues in our industry. Our goal is to ensure the growth and prosperity of our industry for years to come.
I wish all of you a healthy and happy holiday season and I want to thank you all for your support over the years. We promise to continue to fight for our mission to reduce the cost of health care for everyone. Happy reading!
Adam V. Russo, Esq.
CEO |
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Passion for Subro Blog
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.
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Letter from the Editor - The Phia Group, LLC Year in Review - 2011
 | Adam Russo on Inc 5000 and
The Phia Group |
What a year it's been. Our world has endured a lot of change, and our industry was certainly not exempt. We have seen the evolution of a self funded industry in a post-reform world begin to truly take shape. Throughout it all, The Phia Group has been by your side, watching, learning and trying to find new and innovative ways to address our industry's most pressing matters. Our company's personal journey this year has been an interesting one, and we truly hope that the advancements we've seen are merely the beginning of something far greater than we ever expected.
Company Growth
We knew in 2010 that 2011 was going to be a year of great change and transition. We knew and understood that in order to achieve our goals we must ensure that all of our employees truly understood and believe in our mission statement:
"To reduce the cost of Health Care through the use of innovative technologies, legal expertise, and focused flexible customer service."
It is this mission statement that guides our every decision as an organization. From every new client we implement, to each speaking engagement we attend, we do so with our mission of reducing the cost of Health Care in mind.
Read More |
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Press Release - The Phia Group's Adam Russo and Ron Peck draft Amicus Brief on behalf of SIIA in the cases of GPA Holdings, Inc. v. Baylor Health Care Systems
December 15, 2011 - The Self-Insurance Institute of America, Inc. (SIIA) today filed an "initial" amicus brief with the Texas State Supreme Court in the case of GPA Holdings, Inc. v. Baylor Health Care Systems. This initial brief supports GPA's request that the Supreme Court consider arguments to reverse an adverse judgment issued by the Fifth District Court of Appeals. Should the Court agree to hear arguments, SIIA will file a secondary, more comprehensive brief.
At issue is whether third party administrators (TPAs) can be held financially liable for health care services incurred by self-insured group health plans. The Appeals Court declared that such financial liability is lawful.
SIIA's brief, drafted by attorneys Adam Russo and Ron Peck of the Phia Group, LLC., argues such legal interpretation dictates that TPAs would necessarily be deemed as plan fiduciaries, which clearly conflicts with the Employee Retirement Income Security Act (ERISA). More broadly, SIIA contends that the Appeals Court decision threatens the existence of TPAs in Texas and elsewhere, and in turn, would greatly compromise the viability of self-insured group health plans for most employers.
"This case has significant implications for the self-insurance marketplace so SIIA's legal action in support of one of its long-time members is clearly warranted," said association Chief Operating Officer Mike Ferguson. "Unfortunately the number of legal threats to our industry is increasing so SIIA will be announcing a new legal defense initiative after the first of the year."
The full text of the brief can be accessed by members through the SIIA web site at www.siia.org.
This is a developing story so please watch for additional updates from SIIA. |
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The Industry Standard for Plan Language
Check out the Phia Plan Language Service Center
by clicking here -> Plan Language Service Center
Are "Cookie Cutter Solutions" really solutions, if they do more harm than good?
The Phia Group Offers a Real Solution to Self-Funded Plan Document Needs
"If you've met one plan, than you've met one plan." If there is one resonating quote that I hear from administrators all over the Country it's that one. 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 complicated 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 is part of self-funding. Now let's also assume your primary reason for self-funding is your ability to cut costs and produce the most robust yet efficient plan, 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." You may be provided with a specific menu of options to pick from. Since you have no choice, you pick what you feel most closely meets the needs of your benefit plan. At this point, you are probably not too thrilled with your first taste of self-funding.
Read More
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Partnership with WLT
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."
Read More |
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Client Spotlight - GPA
The Phia Group would like to dedicate this month's client spotlight to Group & Pension Administrators in Dallas, Texas. 
GPA has been a client of The Phia Group since 2002 and has recently expanded their relationship with us beyond claims recovery.
On 08/15/11 - GPA announced the introduction of The Phia Group's plan language to enhance their clients plan documents. You can read the official Press Release here.
About GPA
Since 1968, GPA has built a reputation for providing exceptional and custom healthcare benefit management solutions to self-insured employers and employees throughout the Southwest and beyond. Our focus remains: do all possible to ensure your benefit program is successful. Today, this translates into delivering the healthiest employee population and the best bottom line.
Our commitment is the foundation for everything we do. Building relationships and delivering the personalized attention that our extended healthcare family expects and deserves. Employing only the most knowledgeable personnel who solve problems and create solutions. Providing "high-touch" patient care. Investing in industry-leading technology and tools. And, delivering the best value in benefit solutions from cost-management services to employee care. Over time, needs may change ... but our commitment to you stays tried and true.
To learn more about GPA, please visit http://www.gpatpa.com/ |
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Legal Issue of the Month
Just when you thought it was safe...
This past month we were reminded why, as an industry, we cannot rest on our laurels in our subrogation activities. The 3rd Circuit just recently issued a decision that could have important implications on what had seemingly become a Self Funded ERISA Plan's unhindered right to an equitable remedy under Federal Law. In U.S. Airways v. McCutchen, the Plan participant was seriously injured in an automobile accident. Unfortunately, as is too often the case, there was only $110,000.00 available to pay the attorney's fees and costs, reimburse the Plan, as well as reimburse the Plan participant for his losses in the accident.
Read More |
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PGC Case of the Month
DaVita, Dialysis and the Million Dollar Question
Our review of the most recent DaVita quarterly 10-K SEC filing reveals that for the second quarter of 2011, DaVita grossed 1.712 billion and incurred patient expenses of 1.168 billion which represents 68% of its revenue (in Obamacare terms "medical loss ratio") allocated to patient care. The devil is in the details but it is fair to say that dialysis appears to be a very profitable endeavor. In the event a plan member is undergoing dialysis, Medicare in most situations does not become primary until the applicable 30 month coordination period expires. How can a plan lawfully limit this exposure? Is a plan better off carving out dialysis and going out of network? How does the Medicare Secondary payer Act effect payment of claims for plan members who have ESRD?
The Phia group has significant experience handling ESRD/Dialysis issues on behalf of plan sponsors. From drafting the appropriate plan language to handling matters ranging from obtaining overpayments from Dialysis providers to facilitating access to the best network (or no network as the case may be) we can assist you in almost all situations.
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Recovery Case of the Month
This month's case involves a patient who was injured while hunting in the woods. While the member was hunting, a tree stand he was using broke and the safety strap that was holding him up momentarily broke as well, causing him to fall. The patient sustained an excess of $300,000 in charges relating to his injuries.
Due to the fact that the tree stand maker was not only out of business and had no applicable insurance coverage, the patient and his attorney filed suit against the climbing belt company. Despite the patient's excessive injuries, the belt company offered to settle this case for roughly $55,000 arguing that the climbing belt was not intended to be used for hunting purposes and that the belt should only be worn with a safety strap, which the patient neglected to use.
With The Phia Group's excellent negotiation skills, Phia was able secure reimbursement in the amount of $200,000.
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Phia in the Community
The Phia Group is proud to be a contributor to our local Community Food Pantry and Church coat drive by holding an internal food and coat drive over the last few months here at the office.
The Phia Group's Mara Green and the Phia Advisory Board decided earlier this year that we would continue our spirit of giving with these causes. Employees were encouraged to donate any food and coats that they could spare.
On December 8th, Braintree's Local Community Food Pantry sent us a letter of appreciation for our involvement. We truly enjoy being involved in helping the community whenever we can and vow to continue our community projects in the upcoming years.
If you would like to read the letter, you can find it it here. |
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Department of the Month - Client Account Management
This month we would like to spotlight one of The Phia Group's newest departments - Client Account Management. Led by The Phia Group's first employee, Melanie Yates, The Phia Group has dedicated a team to specifically ensure that all of our clients receive the highest level of customer service possible.
With the continued growth of our organization, we recognize that without action, customer service could potentially suffer. Having experienced employees specifically dedicated to managing the numerous inquires we receive, allows that growth to continue without sacrificing our personalized touch. At The Phia Group, customer service is a top priority. We understand that just as we are accountable to our clients (in most cases, the claims administrator); they themselves are accountable to their clients (the plans). Our account management team is dedicated to providing on-the-spot assistance to our clientele for any issue they may have.
Whether a question arises about a new subrogation case or a matter that you are unsure if can we handle - you have a guaranteed source that can give you an answer or put you in touch with someone that can provide one.
Too often, when you call various companies, their customer service seems to do anything but provide service to the customer. Creating long lasting relationships built on clear communication with our clients, is a passion and our duty. |
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Spotlight Employee - Ania Krzywkowska
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Ania Krzywkowska |
Ania has been an employee of The Phia Group since May 2003. As one of the original employees of the Claims Support Department, she has seen the drastic changes that have developed over the years and has acquired a deep understanding of our industry. She has also been part of the Claims Recovery Specialist team and has recently been promoted to The Phia Group's Client Account Management team.
Ania has also taken on the role as team leader of the Phia Advisory Board which cultivates and promotes The Phia Group's culture along with implementing employee ideas and suggestions to better our company.
Ania's passion does not end at the office. The health industry is very broad and due to her interest in the medical field Ania also obtained her phlebotomy certificate in 2008.
In her spare time, Ania enjoys hiking with her puppy Noel, whom she adopted this past summer at the Animal Rescue Shelter in South Boston. She also enjoys any outdoor activity, from a pick-up volleyball game on the beach to spending her winter weekends skiing.
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Upcoming Webinars
"The Industry Standard for Plan Language"
Wed, Jan 18, 2012 1:00 PM - 2:00 PM EST
The Phia Group's Plan Language Service Center is Setting the Standard for Plan Language! Join us as we discuss common errors discovered when assessing existing documents, break down the issues we've identified in today's cookie-cutter templates, and reveal the innovative provisions every plan document must feature to maximize benefits while limiting costs.
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Where in the World is Phia? Do you have a picture of yourself, or someone else representing The Phia Group in a fun or exotic place? If so, submit your photo to info@phiagroup.com, and you may be selected as our quarterly prize winner! |
Presentations To view The Phia Group's past presentations click here. |
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©2000-2011, The Phia Group, LLC | 163 Bay State Drive Braintree, MA 02184 | Phone: 781-535-5600 |
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