The Phia Group's Podcast

In the two years since the Federal Trade Commission issued its internal report on PBMs’ role as middlemen, lawmakers have introduced legislation targeting long-standing industry practices. In this episode of the Empowering Plans podcast, Ron Peck, David Ostrowsky, and Kendall Jackson discuss the latest developments in federal and state law that look to restructure the pharmaceutical supply chain a...

In this edition of the Empowering Plans podcast, Brian O’Hara and Alex Houle of The Phia Group’s Provider Relations department discuss advancements in Artificial Intelligence, how it is being utilized in healthcare, and the ways providers and health plans are using AI to manage NSA dispute resolution. 

In this episode, Garrick Hunt and attorney Kelly Dempsey discuss AI entering the self-funding playing field. From claims administration to the liabilities that may fall on plans and their TPAs, there’s so much to discuss and unfortunately a lot of unknowns. Take a listen and share your thoughts and feedback, which might allow Garrick to make another guest appearance on a Part 2 episode on AI and s...

In this episode of the Empowering Plans podcast, we examine real-world claims that spiraled into appeals, IDR proceedings, provider disputes, participant complaints, and potential litigation in order to demonstrate that a plan can make all the right decisions but still end up in the wrong place. Attorneys Jon Jablon and John Gresh discuss why strong plan language and a defensible rationale are onl...

Tune in for an update from The Phia Group’s CLO, Ron Peck. He’ll bring you up to speed on Phia’s efforts to tackle the hottest topics each month, while also exploring how third-party liability may be contributing to denial and appeal headaches. All while, of course, harassing our podcast producer. Tune in and tune up with Professor Peck!

What separates a denial that withstands judicial scrutiny from one that does not? In this episode, Cindy Merrell explores the key considerations courts may evaluate when reviewing challenged denials. From investigating the facts to clearly articulating the basis for a decision, this episode identifies practical steps that can help administrators improve outcomes and mitigate litigation exposure. 

In this week's episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O'Hara break down the Third Circuit's recent decision in Ahn v. Cigna and what it means for ERISA preemption and explanation of benefits (EOB) language.

On this episode of the Empowering Plans podcast series, Attorneys Kelly Dempsey and Naga Vivekanandan discuss recent 340B litigation filed by three major hospital systems. They explain how the 340B program works and summarize the allegations in the lawsuit, as well as explore what these cases could mean for contract pharmacy arrangements and self-funded plans. 

On this episode of the Empowering Plans podcast series, attorneys Jen McCormick and Nick Bonds talk through some of the pressures self-funded plans face from every direction -- rising member costs, PBM opacity, shifting coverage models, and instability in the individual market. The plans that respond well are those with clear governance and the ability to keep track of who decides, who communicate...

On this week's Empowering Plans Podcast, attorneys Ron Peck and Nick Bonds discuss the growing popularity of alternative healthcare arrangements. What's driving interest in these alternatives? What financial pressures are fueling their growth? Can they deliver on their promise? In a landscape of ever-increasing healthcare costs, these arrangements often offer a more affordable alternative to tradi...

In this installment of The Phia Group’s Empowering Plans podcast, attorneys Kendall Jackson and Jon Jablon break down the Medicare Secondary Payer Act and what it means for self-funded group health plans. From prohibited incentives to noncompliant plan language, and the surprisingly thin line between educating and encouraging employees about Medicare, this episode covers the compliance pitfalls th...

Join attorneys Cindy Merrell and Bryan Dunton as they take a deep dive into real-world cases involving the No Surprises Act. Cindy and Bryan break down how the Act is being applied, highlight common issues and pitfalls, and discuss what these cases mean for payors, providers, and other stakeholders navigating these billing disputes.

It is time again for the fastest 20 minutes in podcasting as Cindy Merrell and Corey Crigger take over the Empowering Plans podcast to preview The Kentucky Derby. Don’t worry, this podcast isn’t solely about horse racing! Cindy and Corey also discuss two big news items that affect the healthcare industry – litigation surrounding Roundup and a major article in the New York Times about the No Surpri...

As a follow-up to this past January’s podcast episode on tobacco surcharges, new litigation has been filing and this time, it’s on a much larger scale. Humana is facing a class-action lawsuit, filed on March 17, 2026, alleging violations of the wellness program rules and fiduciary duties related to tobacco surcharge as part of a wellness program. Join attorneys Kelly Dempsey and Naga Vivekanandan...

On this week’s Empowering Plans Podcast , Attorneys Jen McCormick and Nick Bonds talk through a federal district court case out of Massachusetts that has put a preliminary pause on vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP) – and why the case has broader potential implications than it may initially appear. They break down what happened, why the court inter...

On this episode of the Empowering Plans podcast, attorney Ron Peck engages in a one-on-one discussion with YOU, regarding two of the “hottest” topics being discussed on the road.  Don’t be left out; tune in now!

On today’s episode of the Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson discuss the current state of the No Surprises Act (NSA) and the Independent Dispute Resolution (IDR) process. From difficulties managing dispute volume to current litigation and legislative proposals, this episode provides key insight into changes to and challenges with the IDR process.

In this installment of The Phia Group’s “Empowering Plans” podcast, attorneys Bryan Dunton and Cindy Merrell discuss what happens when laws evolve faster than contracts, and how many compliance failures live in old documents. This episode breaks down how legacy contract language creates modern risk under HIPAA Part 2 and emerging PBM transparency reforms, particularly where downstream data sharing...

In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O’Hara share the latest information TPAs and employer plan sponsors need to know about the No Surprises Act. The discussion focuses on recent federal guidance, updated arbitration data, key court decisions affecting NSA enforcement, and practical takeaways for managing provider billing disputes and controlling plan...

Tobacco surcharges have long been a common cost containment wellness tool for self-funded plans, but recent lawsuits are putting them under the microscope. In this episode, attorneys Kelly Dempsey and Naga Vivekanandan break down how tobacco surcharges work, why they are treated differently under federal law, and what recent court decisions mean for employers navigating wellness program risk.

In this episode, Phia Group legends – CLO Ron Peck and EVP Jen McCormick – dive deep into waters rarely discussed.  They contemplate how the rising costs of healthcare impact employers and their employees in areas outside of healthcare – from hiring to counting steps.  Join them as they share insight into this, and how to get employees and their families to embrace healthcare literacy, and positiv...

This week on the Empowering Plans podcast, attorneys Corey Crigger and Nick Bonds dig into the growing movement to use psychedelics in treating mental health and substance use disorders. As states ramp up research and regulation, they unpack what’s driving this shift — and what health plans should watch for in a changing compliance landscape.

In the latest installment of The Phia Group’s “Empowering Plans” podcast, attorneys Kendall Jackson and Jon Jablon explore Essential Health Benefits – an important facet of self-funded health plans that seems straightforward, but has garnered a great deal of confusion and misconception through the years. This episode touches on the significance of state benchmark plans, the difference between EHBs...

Join attorneys Bryan Dunton and Cindy Merrell as they discuss what happens when the No Surprises Act collides with subrogation. They explore the practical implications of the legislation, including how it intersects with common recovery models like “pay and chase” and “pend and pay.” This conversation offers valuable insights into how the Act may affect your approach to healthcare claims and reimb...

The rules around COVID coverage are entering a new phase. attorneys Kelly Dempsey and Naga Vivekanandan as they explore how recent ACIP guidance narrows preventive coverage for COVID vaccines and what it means for both PPO and HDHP plans. They also dig into the gray areas employers face when updating plan documents and how participants may see their costs shift.