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The Phia Group
The Phia Group, LLC

October 15, 2013
Quarterly Newsletter
Third Quarter 2013
In This Issue
The Book of Russo - From the Desk of the CEO


Ill be honest with all of you - did I think back in 1999 when I formed The Phia Group with my college buddy Mike Branco that this company would become what it is today?  The answer is I had no idea what I expected this company to become.  I was just doing something that I loved and thought if I could make a living doing it then that would be "wicked" cool.  We have blown away any expectations we have 14 years ago and the fact remains we have much more to do.


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Stop The Presses!


New York, August 22, 2013 - Inc. magazine today ranked The Phia Group on its annual Inc. 500|5000; an exclusive ranking of the nation's fastest-growing private companies.  The list represents the most comprehensive look at the most important segement of the economy-America's independent entrepreneurs.  The Phia Group joins LivingSocial, Edible Arrangements, CDW and Lifelock, among other prominent brands featured on this year's list. 


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Letter from the Editor
The winds of change are coming, and they blow closer than ever. It seems so recent that we were all looking forward to 2014, and feeling confident that we had plenty of time to get things in order and prepare - both financially and in terms of compliance - to address President Obama's sweeping healthcare[insurance] reform law. Yet here we are, clueless as ever and full implementation looming.
From the Blogosphere -
The Stacks


PPACA - International Law of Mystery

By: Jon Jablon, Esq.


A couple of months back, we received an inquiry from a client TPA asking whether a group located outside the United States will be obligated to comply with the employer mandate (affectionately known as "pay or play," "play or pay," or sometimes even vaguely "the tax" or just "that penalty") and whether non-citizen employees working in the United States will be obligated to comply with the individual mandate (generally known only as the "individual mandate;" this term generally does not rise to the level of receiving disdainful nicknames because that penalty is more complicated than the individual mandate and noncompliance with that penalty is potentially more detrimental to our clients).


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Attack of the Killer P's - Providers Paying Patients' Premiums

By: Sean Donnelly


A recent and unsettling trend in the healthcare industry involves medical providers paying insurance premiums or contributions on behalf of their patients in order to ensure that the patient's coverage remains active.  Providers engage in this practice because it is largely cheaper and easier to prolong a patient's coverage and continue charging exorbitant amounts to the patient's health plan or policy than to try and collect directly from a patient who would otherwise no longer qualify for coverage - a struggle that providers view as being akin to squeezing blood from a stone.


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How the Supreme Court's Ruling on DOMA Affects Self-funded Plans

By: Jennifer MCCormick, Esq. and Corrie Cripps


United States v. Winsdor


On June 26, 2013, the U.S. Supreme Court in United States v. Windsor struck down "Section Three" of the Defense of Marriage Act (DOMA), which prevented the federal government from recognizing any marriages between gay or lesbian couples for the purpose of federal laws or programs, even if those couples are considered legally married by their home state. The other significant part of DOMA makes it so that individual states do not legally have to acknowledge the relationships of gay and lesbian couples who were married in another state. Only the section that dealt with federal recognition was ruled unconstitutional.


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Grabbing the Wheel: Directing Member Steerage

By: Sean Donnelly, Esq.



"People with chronic conditions generally use more health care services, including physician visits, hospital care, and prescription drugs.  Increases in the number of people living longer with chronic conditions coupled with rising health care expenditures have spurred health plans and employers to look for ways to reduce health care use and costs.  Disease management is one approach that aims to provide better care while reducing the costs of caring for the chronically ill by rewarding Participants for participating in select programs, such as by offering them a credit towards the following year's deductible.  Disease management programs are designed to improve the health of persons with specific chronic conditions and to reduce health care service use and costs associated with avoidable complications, such as emergency room visits and hospitalizations. ("Disease Management Programs: Improving Health While Reducing Costs?", Georgetown University Center on an Aging Society (2004))."


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A Revolutionary Passion for Savings!
Old Problems Renewed...
By: Christopher Aguiar

In this edition of The Phia Group's Quarterly Newsletter, I decided to highlight a problem that has been around for quite some time, but one that has recently seemed to rear its ugly head; Signed Subrogation Agreements!


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Employee of the Quarter - Naviana Anderson
Naviana joined The Phia Group in March 2007 as part of the Case Support. Because of her her certificate in Medical Coding and Billing and her natural ability, Naviana was quickly promoted to Team Leader in 2009, and with hard work, diligence and passion, she was again promoted to Supervisor in 2010. Naviana took on the role as Lead Trainer of the Case Support Department, where she is solely responsible for training all new and existing employees within the department.   Naviana is the cornerstone of her team and is always the first to go above and beyond the scope of her ever expanding duties.


This quarter, Naviana was named "Employee of the Quarter".   She received significant praise and nominations from across many departments at Phia.  Her trainees comment on how "She has been extremely supporting, always takes time to assist me with any problems.  She is a leader and very dedicated, I personally witnessed this during the last big project that was rolled out.   She took on the extra work, stepped right up and put in the long hours and never once faltered. She did this all while filling in for her manager by overseeing the investigation and customer service unit, also the case support unit. She always had a great attitude and I never felt that I couldn't approach her with a question or problem.  She is a leader I look up to and I'm happy to be a part of her team."


Managers from in and out of her own department rave "She is the ideal employee and co-worker, leading by example and always keeping her head high even when times are tough.  She doesn't just step up to the plate and produce, she hits Grand Slams and is a true All Star!" and "She is hard working, dedicated, patient, positive, knowledgeable, always willing to help, professional, etc. She is a huge asset to Phia!!"

The Phia Group, LLC's Services
Increase Plan Savings * Streghten Plan Rights * Resolve Plan Conflicts
Subrogation & Right of Reimbursment - We identify opportunities and apply legal knowledge to maximize recoveries.
  • Case by Case Referals
  • Full Subrogation Services
Overpayment Recovery - Regardless of the cause, we will seek recoupment of overpaid claims.
Coordination of Benefits - Analyze applicable provisions and help ensure the primary payer pays first.
Initial Plan Document Assesment - Evaluation the entire plan document and identify opportunities to stengthen plan rights.
General Plan Document Consultation - Pinpoint issues and customize plan language to meet plan sponsor needs
Plan Provision Review & Revision - Analyze plan langauge, make reccomendations, and provide revised provisions.
Innovative Plan Document Drafting - Develope plan documents customized to meet client specificationa and contain costs.
  • Custom Sing Plan Design
  • Custom Template Design
  • Template Review & Revision

Consulting Services


Third Party Agreement Review & Revision - Review agreements to reveal conflicts, as well as provide revised terms.

  • Stop Loss Contracts
  • PPO Contracts
  • ASA Agreements

Dispute Resolution - Assist with grievances and manage conflicts.

  • Combat Balance Billing
  • Defend Claims Processing
  • Resolve Stop Loss Disputes
  • Respond to PPO Conflicts

General Healthcare Consulting - Quickly assess clients' needs, recommend options, and develop customized solutions.


The Phia Group, LLC | 781-535-5600 | |
163 Bay State Drive
Braintree, MA 02184

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