Phearless Advocacy: Self-Funded Plans Lead the Way
Hard working Americans deserve robust health benefit plans, and employers want to provide them with access to high quality, affordable coverage. The Phia Group’s mission is to make this a reality.
Health care costs too much. That cost is increasing. This forces employers to offset costs onto employees through higher co-pays and deductibles. The result—the cost of providing health benefits to employees is increasing.
The Phia Group is comprised of two sister organizations: The Phia Group, LLC and Phia Group Consulting, LLC. They share a simple mission—reduce the cost of health benefits using technology, legal expertise, and focused flexible customer service.
The result? Making health benefits affordable for employers and employees. Employers working with The Phia Group “empower” their plans; maximizing benefits and minimizing costs.
The Phia Group begins by promoting and educating employers about self-funding their health plans. Next, they create and implement cost containment services, while delivering solutions meant to meet specific client needs.
The Phia Group story begins in 1999 with two friends in a basement in Quincy, Massachusetts. Founders Michael Branco and Adam Russo combined their knowledge and experience with data analysis, finance, and law to create an innovative approach to coordinating benefits between health benefit plans and other “third party” payers.
They began by accepting claims data directly from third party administrators (TPAs) who were processing claims on self-funded employer plans’ behalf. Next, they painstakingly analyzed the entirety of the (at the time) current ICD-9 billing codes to identify any and all that might relate to injuries caused by a third party, or for which a third party might be responsible for payment.
Next, they built—from the ground up—a proprietary system that could analyze the aforementioned claims data. The system applied the coding rules, flagged “groups” of claims that appeared to relate to an incident giving rise to third party payment responsibility.
As their ability to identify such opportunities evolved, so too did their ability to maximize the amount of funds recovered on a per-case basis.
Applying legal knowledge and a unique talent for negotiation, The Phia Group’s team of claim recovery specialists grew; eventually becoming the health benefit industry’s most renowned subrogation team.
To strengthen their efforts further and ensure self-funded health plans would only pay the right amount at the right time to the right entity, The Phia Group then began drafting subrogation, reimbursement, and third party liability provisions for their clients’ plan documents.
This very limited service soon expanded, until The Phia Group found itself being asked to draft entire plan documents. Drafting documents soon evolved into assisting plan administrators with the application of those terms to claims, consulting on claims processing and legal compliance. The creation of Phia Group Consulting soon followed.
The Phia Group has grown both in the size and scope of services working with entities coast to coast, and in all 50 states. The Phia Group’s goal and passion is and always will be empowering self-funded plans to maximize benefits while reducing costs through innovative plan architecture, robust cost containment services, and offering clients a means to protect themselves against looming fiduciary liability and unjust billing or abusive practices.
Now headquartered in Braintree, Massachusetts, The Phia Group is a recognized leader in cost containment within the health insurance industry. They have secured this reputation by forging partnerships with and providing unrivaled results to their clients; a group that includes (but is not limited to) employers, third party administrators, stop-loss insurance carriers, and broker advisors.
Providing the most effective cost containment tools to combat the increasingly high cost of health care, The Phia Group boasts a large and ever-growing team of industry recognized attorneys and specialists. Constantly leveraging proprietary technology, The Phia Group is poised to shape the future of healthcare, and is committed to the preservation of the self-funded industry.
The Phia Group Silos
The Phia Group’s services can now be divided into four silos: Learn, Plan, Save and Protect.
They help clients “learn” by providing best-in-class consultative services and compliance guidance, especially through its subscription based Independent Consultation and Evaluation service or “ICE.” With ICE, clients receive unlimited access to The Phia Group’s team of attorneys, specialists, and answers to all questions regarding benefit plan administration and legal compliance.
Next, The Phia Group helps clients “plan,” by reviewing, revising, and drafting benefit plan documents. This can be done on a per-plan basis, or via their web-based plan creation software, Phia Document Management (or “PDM”). These services also include access to their best-practices template—The Phia Flagship—summary of benefits coverage (SBCs), and “gap-reviews,” whereby they compare the plan to other binding documents and contracts; pinpointing inconsistencies and conflicts before they cause trouble. The Phia Group also helps clients “save” by delivering subrogation (third-party claim recovery services), overpayment recoupment, large claim negotiation, and out-of-network repricing services.
Finally, The Phia Group’s plans are protected, thanks to defense provided by The Phia Group. Whether it is shifting fiduciary liability for final appeal decision making onto The Phia Group, acting as a Plan Appointed Claim Evaluator (PACE), or defending a plan’s pricing methodology in the face of pushback, The Phia Group “protects” the plan.
Committed to education and guidance, The Phia Group provides various free informational webinars and podcasts that provide the most cutting innovations, legal and regulatory updates, and state of the industry trends. The Phia Group’s passion is bottomless and they are committed to creating a more affordable healthcare system.
To date The Phia Group provides services to TPAs, ASOs, stop-loss carriers, reinsurance carriers, MGUs, and brokers; representing municipal health plans, multi-employer health plans, and self-funded health plans.
The Phia Group also works with government agencies, Medicare and Medicaid plans, Taft-Hartley entities, High Risk Pools (state and federal), as well as other consortia. Together, these entities represent thousands of employer-sponsored health plans covering millions of lives nationwide. The diverse nature of these organizations means The Phia Group is equipped to handle any problem with the highest level of professionalism and expertise.
This level of passion for the self-funded industry has led to The Phia Group being a prominent figure in many leading industry organizations. Executives and employees sit on boards of the most well respected industry organizations and travel across the country to present new ideas, The Phia Group is proud to share its passion nationwide, and looks forward to helping every person take back control of their health care and empower their plans.