In Part 2 of their conversation, Captivating Health Insights host Maddison Bezdicek welcomes back Adam Russo, Co-Founder and CEO of The Phia Group, to discuss fiduciary responsibility—one of the most overlooked and misunderstood obligations for self-funded employers. Russo explains why employers, not TPAs or brokers, ultimately bear the legal responsibility for final-level claim decisions—and how failing to understand this can lead to lawsuits, reputational damage, and regulatory exposure. He shares real-world stories that reveal just how complex claim decisions have become in an era of AI-driven reviews, million-dollar claims, and mounting audit pressure. Russo also explains how Phia’s fiduciary model (PACE) helps employers ensure compliance, transparency, and fairness—protecting both the plan and its members. His message is clear: awareness, data, and expert support are key to staying compliant, compassionate, and protected.
Chapters
- (00:00:55) - Welcome Back: Part Two with Adam Russo
- (00:01:19) - What Does It Mean to Be a Fiduciary?
- (00:01:30) - The Million-Dollar Claim Story
- (00:03:33) - Who Actually Decides If a Claim Is Payable?
- (00:05:22) - The Birth of PACE: A Fiduciary Solution
- (00:06:53) - From “Take It Under Advisement” to “How Do I Fix It?”
- (00:08:04) - Legal Meets Clinical: Making Smart Claim Decisions
- (00:09:52) - The Rise of Complex Claims and AI Denials
- (00:12:00) - The Stop-Loss Dilemma
- (00:13:10) - The $100 Million Claim Era
- (00:14:00) - The HR Dilemma: When It Gets Personal
- (00:15:28) - Ignorance Isn’t a Defense
- (00:16:11) - Captives, TPAs, and Fiduciary Duty
- (00:17:59) - Knowing You’re Responsible
- (00:18:58) - Final Takeaways: Don’t Take It Lightly
- (00:19:07) - Closing Thoughts
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