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The Phia Group
The Phia Group, LLC

April 7, 2014
Quarterly Newsletter
First Quarter 2014
In This Issue
The Book of Russo - From the Desk of the CEO

Well... "ObamaCare" is here, and so are we.  The sun continues to rise in the east, and set in the west; and business goes on.  Some of you have reaped the benefits of change, while others have suffered; but the reality is that for most of the industry, not much has changed.   


To read all of this quarter's "Book of Russo," click here



TAKE NOTE - A New Phia Service!  


The Phia Group has been compiling a massive inventory of PPO agreements. We have been reviewing each agreement extensively, comparing the agreements and their provisions, and developing a robust database of knowledge regarding trends in the agreements of particular networks and in the industry in general. We are interested in ascertaining the rights of both the benefit plan and the network with respect to what amounts must be paid within what timeframe, and subject to what terms and conditions. We welcome more PPO agreements for our analysis; we are confident that this extensive research project will develop further and be advantageous to our clients and the industry as a whole. If you have a network agreement you'd like to add to our ever-growing library, please consider sending it to us at


PAST WEBINARS: You can find free copies of our most recent industry-acclaimed webinars here - As always, we welcome your comments, questions, and ideas for future presentation topics. Enjoy! 


For more information about our services, please visit us at ...


"Stop the Presses!!"  

Connecticut Becomes a Self-Insurance Battleground


Earlier this month, the Connecticut legislature introduced Senate Bill 479 which posed a significant threat to the state's self-funding marketplace. The proposed stop-loss legislation would have resulted in Connecticut having the highest attachment point of any state in the country.


To read all of this quarter's "Stop the Presses," click here...


SIIA Leads Charge to Pass Bill Defining Stop-Loss as Financial (not Health) Insurance


In other SIIA-spearheaded efforts, President and CEO Mike Ferguson recently testified at a hearing on self-insurance before the House of Representatives' Subcommittee on Health, Employment, Labor and Pensions. Ferguson explained to the subcommittee that stop-loss insurance is more closely related to liability insurance than health insurance, stating that "Unlike health insurance, stop-loss insurance does not cover individuals nor pay health care providers regardless of attachment point levels. Stop-loss insurance can only reimburse the sponsor or the plan for health payments in excess of the attachment point."



From the Blogosphere -
 (1) Nearly Half of Employers Considering Private Exchanges: 

(2) One-Third of Uninsured Americans Plan to Remain Uninsured:


(3) Reform Update: Narrow networks bring equal parts controversy and savings:


(4) The Healthy, the White, and the 50-Plus Are Most Likely to Oppose Obamacare:
The Stacks


"Self Funded Benefit Plan With Clear Language... PRICELESS!" by Pamala Parette; Senior Claims Recovery Specialist


Self funded health benefit plans ("Plans"), simply defined, are NOT FOR PROFIT health benefit programs.  Premiums paid by each participant are thrown into a bucket.  From this bucket of cash... health benefits, expenses, and risks of managing that bucket are paid.  Setting a solid base in the foundation of the bucket (with clear Plan language) is crucial in controlling intended, and unintended, costs... and building the cash bucket for future viability. 


 To read all of this quarter's "The Stacks," click here... 


Get to Know... 2013 Employee of the Year!  


Nick Murphy -  Supervisor, Claim Assessment & Project Lead   


Nicholas Murphy started his career at The Phia Group back in 2006. An extremely disciplined and dedicated employee, he frequently volunteers for unique projects and suggests ways to improve Phia. He works diligently to make Phia a great business and a great place to work. 


He is now simultaneously a Supervisor of the Claim Assessment department and a member of the Project Management team, working directly with VPs and the CEO to promote new ideas and solve problems. He is an avid lover of philosophy, technology and a good craft beer."




I. Charitable Days Ahead  


This year, The Phia Group is excited to be working with Adoption Choices/JFS of Metrowest. 


To read all of this quarter's "PhiaNews," click here...

JFS of Metrowest (JFS) provides vital social, health and community services to alleviate suffering, enhance lives and support people in need.  They are dedicated to:


  • Supporting people of all ages and backgrounds; 
  • Treating people with dignity and compassion; 
  • Helping people achieve and sustain healthy lives and independence;
  • Providing culturally relevant services;
  • Collaborating with community partners to broaden our impact;  
  • Be a leader and catalyst in providing the best social, health and community services with special responsibility to vulnerable children, families and elders; and,
  • Develop and deliver essential services to assist those in need.


This year, The Phia Group has committed to work with JFS to provide support to the Goss Adoption Fund and the Julia Michelson Fund which is focused on creating education programs for adoptive families.  In addition, Phia will be actively involved with JFS' Reducing Achievement Gaps Program at the Woodrow Wilson School in Framingham, Massachusetts serving over 530 very low income and immigrants, with families having numerous challenges and a large scale summer project for all Phia employees at the Woodrow Wilson School.


II. Movin' On Up


The following people are taking on new opportunities with the Phia Group, LLC:

  • Ashley Enyeart has expanded her role in the legal department and become the Paralegal Manager
  • Mara Green has transitioned from a claims analyst in CA to a member of our Client Account Management Team.
  • Cara Carll & Kerri Sherman both received their Paralegal Certificates.
  • Renee Karvelas passed the 1st party test & is now a Claim Recovery Specialist III, handling 1st party cases in addition to CNIS & school insurance.
  • David Arroyo moved from Customer Service to Case Investigation.
  • Tianna Pagan moved from a Claim Recovery Specialist III (med pay) to a Claim Recovery Specialist IV (WC)
  • Ashley Schramm moved from a Case Investigator to a Claim Recovery Specialist II
  • Kerri Sherman made a lateral move to Claim Recovery Specialist IV but passed the BI test to be able to handle BI cases instead of WC
  • Brittani Hunter moved from a Claim Recovery Specialist I (beginning level, pending/CNIS) to a Claim Recovery Specialist IV (WC)
  • Leiana Turner moved from a Case Handler Assistant to a Case Investigator
  • Igor Senic moved from a Overpayment Recovery Assistant to an Overpayment Recovery Specialist
  • Esther Oliveras moved from Customer Service to Accounting

III.  A Growing Phia Phamily  


The Phia Group is proud to announce the First-Quarter Hiring of the Following Incredible Individuals:


Nicholas Gatanti - Claim Assessment

Jason Kemp - Claims Recovery

Jacob Turner - Claims Support

Shannon Burns - Claims Support

Jimena Williams - Claims Support

Derrek Mish - Claims Support

Lyneka Hubbert - Customer Service Representative

Brianne MacAusland - Legal

Elizabeth Welcome - Office Management

Kelly Dempsey, Esq. - Phia Group Consulting

Kim Khuu - Phia Group Consulting

Michelle Hay - Phia Group Consulting

Opening Day ... in Cleveland???!??!


No need to adjust your contacts, we have not moved to Cleveland! Through Adam Russo, though, every year Cleveland takes over our office on Baseball Opening Day.   


Check out pictures of our annual Cleveland Indians Opening Day Event where once a year, roles are reversed and Adam Russo is the one taking orders for a change; Hot Dog orders, that is!


Hopefully, Adam is as excited on day 162 of the season as he is prior to day 1 ... only time will tell! 



Hotdog Day  


The Phia Group's  Services
Increase Plan Savings * Strengthen Plan Rights * Resolve Plan Conflicts
Subrogation & Right of Reimbursement - We identify opportunities and apply legal knowledge to maximize recoveries.
  • Case by Case Referrals
  • Full Subrogation Services
Overpayment Recovery - Regardless of the cause, we will seek reimbursement of overpaid claims.
Coordination of Benefits - Analyze applicable provisions and help ensure the primary payer pays first.

Initial Plan Document Assessment
- Evaluation the entire plan document and identify opportunities to strengthen plan rights.
General Plan Document Consultation - Pinpoint issues and customize plan language to meet plan sponsor needs
Plan Provision Review & Revision - Analyze plan language, make recommendations, and provide revised provisions.
Innovative Plan Document Drafting - Develop plan documents customized to meet client specification 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
Innovative Claims Pricing Consultation - Working with you to implement alternative pricing methodologies.
  • Implementation - Provide template materials and tools (such as plan provisions, correspondence, ID cards, EOBs, and more), necessary for the development, preparation and rollout of new, alternative claims processing methodologies
  • Coordination - Work side by side with the plan, administrator, and subcontractors regarding the utilization and defense of reference based pricing
  • Defense - Defending the benefit plan's right to utilize its reference based pricing
Regulatory Compliance - Navigate the complexities of regulatory law as they relate to the health care industry.
  • State or Federal Regulation - Issues involving State Insurance Departments, the NAIC, HHS, CMS, and DOL
  • Plan Status and Rights - Identifying benefits of funding status and enforcing applicable rights

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


2000-2014, The Phia Group, LLC | 163 Bay State Drive Braintree, MA 02184 | Phone: 781-535-5600 | Fax: 781-535-5656 

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