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The Phia Group
The Phia Group, LLC

July 08, 2014
Quarterly Newsletter
Second Quarter 2014
In This Issue
The Book of Russo - From the Desk of the CEO


What a spring we have had here at The Phia Group. From travelling across the country speaking at various venues, hosting our own Phia Forum a few weeks ago, to our new service offerings; we have been extremely busy here at the home office. Now that the summer is here, you would expect that things would slow down but that's not the case at all. As the temperature rises, so does our work load, as the number of issues facing the self insured industry continues to grow. Who said that health insurance is boring!?!?!?


As you'll read in Ron Peck's entry below, as the skies cleared and the sun shined, we "saw the light" and realized that many of our clients want flat fees for our services, and in response to your desires, we have developed a number of flat fee rates for some of our most popular services. This is just one more example of The Phia Group exercising its flexibility in execution of its mission to provide customized customer service.    


Our Forum in June was a great success as well, with many of the industry's thought leaders sharing their opinions on the latest industry issues. In addition, we recently announced the formation of our Phia Document Management ("PDM") software, which I know will change the industry for the better. We spent two years building this software and I think it blows away the competition. Like our other services, instead of cookie cutter software that is not built with the self insured industry in mind, our program is custom tailored to the unique needs of you and your clients. I want to take this opportunity to thank our many beta clients who tested our software over the past 24 months.


Lastly, there were some very interesting cases that came out of the courts from the Supreme Court Hobby Lobby case to the unique decision in California's Fifth District Court of Appeals (in the matter of Children's Hospital Central California v. Blue Cross of California); all of which we discuss in this issue!


How we as an industry process, audit and pay claims may drastically change based on these and other decisions. While perhaps a bit scary, these cases have allowed us here at The Phia Group to develop innovative approaches to old methodologies. I hope you enjoy this issue and the summer months ahead. Happy reading!


Letter from the Editor

I can only speak for myself, but I am sweating. Our office enjoys climate control, so the hot summer sun is not to blame. Instead, we're feeling the heat as we work hard to stay abreast of ever-changing laws, ensure our clients' compliance, research and comment upon many new innovative plan administration theories, methodologies, and cost containment theories.


For The Phia Group, Phia Group Consulting, and our amazing clients - summertime is no time to relax. Instead, we're all examining the laws - new and old - in an attempt to face challenges head-on and instead identify opportunities created by change.


With this in mind, we wanted to take this opportunity to remind you that we are here to provide you with the industry's best subrogation, claim reimbursement, and overpayment recovery services as well as a full spectrum of consulting and document review, revision, and drafting services. Of course we're known for our "Passion for Subro," but are you aware of the other ways we act upon our revolutionary passion for savings? Please allow me to share with you some of the lesser-known services we offer. We don't think our beloved industry, clients, and partners are fully aware of the many services we offer; and my mission is to change that!


So, before you start planning your camping trip, beach getaway or "staycation," please allow us to familiarize you with some of our valuable offerings. In addition, in response to popular demand, Phia Group Consulting ("PGC") has developed a convenient menu of flat-rate services. The days of indefinite costs and billing surprises are over! Our intent is to outline each service and provide you with a simple price breakdown of each. The following flat fees are attached to services designed to assist benefit plans and those that service them; from document drafting, to consulting and beyond!

To read all of this quarter's "Letter from the Editor," click here.

Stop the Presses 


The 2014 Phia Group Forum is a Success!



Between Monday, June 16th and Wednesday, June 18th, many of the self-funded health benefits industry's leaders gathered in Boston for The Phia Group's 2014 Phia Forum. This year, the event took place in Boston's luxurious Fairmont-Copley Hotel. More impressive than the venue, however, was the breadth of topics addressed and ideas shared by the brilliant minds present.


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



Phia Group Consulting, LLC Formally Announces the Creation of its Phia Document Management ("PDM") Software



A first of its kind plan document drafting solution, Phia Document Management ("PDM") was created to satisfy the needs of the entire health plan industry.  PDM allows for instant population of an online template featuring The Phia Group's acclaimed plan language, while also being customizable enough to meet each client's unique needs.


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

The Stacks  


Overpayments... Over?


Illinois Federal Court Issues a Troubling Decision Declaring Overpayment Recoupment to be Identical to Claim Denials; Requiring ERISA Compliant Notification of Adverse Benefit Determination, and Rights of Appeal for the Provider


Any and all entities involved in the payment of claims must become familiar with the case of Pa. Chiropractic Ass'n v. Blue Cross Blue Shield Ass'n,No. 09 C 519, 2014 WL 1276585 (N.D. Ill. Mar. 28, 2014), and its impact on the pursuit of overpayment refunds![WU1] 


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

Courts Willing to Treat Healthcare Like a Consumer Good?


Generally speaking, courts of law will enforce contracts (including prices) when the two or more parties to the contract discuss what is to be provided (services or supplies) and the price to be paid (monetary or otherwise). This is true even if everyone else - the court included - feel that the price agreed upon is excessive or extremely low. The reasonableness of the agreed upon price is not the court's concern. Rather, the enforceability of the contract is their only concern, when the terms were otherwise agreed upon.


In cases where no "meeting of the minds" occurred (the parties didn't agree on a price for services or supplies before those services or supplies were provided to the consumer), the consumer does not get to walk away free-of-charge. If someone receives valuable services or supplies without paying anything, (and those services are not a "gift"), that consumer would be "unjustly enriched."


When a consumer is "unjustly enriched," the entity that provided the service or supply can demand compensation. There was no agreed upon price, however, so the supplier of the services or supplies cannot direct the court to enforce the agreed upon price. In such instances, the court requires all those involved in the dispute to present evidence setting forth the fair market value of the services or supplies. No; the supplier cannot unilaterally set a price and demand that the price be paid... a scenario unique to the healthcare sector. Unique to healthcare, that is, until now...


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

Get to Know... The Employee of the Quarter!

Ashley Enyeart has been an integral member of The Phia Group since 2007.   She quickly rose through the ranks of the recovery department and spent several years handling thousands of complex subrogation cases involving third party liability.   Recognizing her obvious talent and passion, managers of our recovery team recruited her to assist them with the highest level files in the department. Before long, she became a member of our legal team where she quickly took on the role of lead paralegal. In addition to acting as the right hand of our Senior Vice President/General Counsel, Ron Peck, Ashley provides initial and ongoing training for the paralegals in our legal department.


Employees, managers and VP's alike rave about her "candor and professionalism in the face of a rapid fire environment with many tasks, deadlines and shifting expectations." "Ashley is one of the key contributors towards our growth and success. She is passionate about her work, and our work as a whole. She is honest, dependable, and expects more of herself than anyone else - leading to exceptional levels of integrity and accountability."



Phia News

Phia Gives Back:

As is our tradition for the past several years, The Phia Group partners with a local charity where we invest our time, money and support to ensure a successful program. We not only make monetary donations, but also collect needed items and have a company-wide day off so that our employees can volunteer their time and efforts to the cause. This year we have chosen to work with Jewish Family Service of Metrowest (JFS).  

JFS provides vital social, health, and community services to alleviate suffering, enhance lives, and support people in need. The program that The Phia Group is involved with is the Reducing Achievement Gaps program (RAG). RAG is a comprehensive system of interventions to address the academic and social needs of poor children of immigrant families in Framingham, Massachusetts, located 30 miles from our office in Braintree.  


RAG is based at the 550 student Woodrow Wilson Elementary School, located in Framingham's poorest and highest-crime neighborhood. RAG gives Framingham's most economically and educationally challenged school age children and their families the help and resources they need to succeed in school and in life. Please click on the link to this video to learn more:    



The Phia Group recently held a very successful recess drive for Woodrow Wilson Elementary School, and raised over 250 items for the students' after school programs.  


The Phia Group will be spending the day at Woodrow Wilson Elementary School for our annual volunteer day in July. We are going to help the school with various tasks, such as: planting and expanding the school vegetable garden, fixing the concrete school yard by repainting lines, a US map, and other recess games, enhancing the playground by purchasing and installing additional equipment, and interior painting of classrooms and the gym.


We would love to be able to provide the students of Woodrow Wilson Elementary School with everything they need, and would greatly appreciate any donation from you. If you would like to make a donation you may do so by visiting: /JFS_giving.html?action_donateReport=1&partner=networkforgood&ein=04-2730898, or by mailing a check made payable to JFS of Metrowest to The Law Offices of Russo & Minchoff, 123 Boston St., 1st Floor, Boston, MA 02125

New Faces at Phia


Kayla Catarella:          Accounting Administrator

Geraldine Legros:      Claims Recovery Specialist Assistant

Andrew Silverio:        Attorney

Adam Fralick:             Customer Service Representative


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

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