In Episode 10 of Captivating Health Insights, host Maddison Bezdicek continued her conversation with Adam Russo, Co-Founder and CEO of The Phia Group, to discuss another misunderstood obligation in self-funding: fiduciary responsibility.
Russo explained that most employers don’t realize they — not the broker or third-party administrator (TPA) — are the fiduciary responsible for determining whether a claim should be paid. When a final-level appeal arises, employers are legally accountable for that decision. Ignorance isn’t an excuse — and when claims end up in court or the news, it’s the employer’s name on the headline.
Russo shared how this realization led The Phia Group to create PACE, a fiduciary transfer model that handles final-level appeals with precision in both legal and clinical aspects. By independently reviewing claims, The Phia Group protects both the employer and the employee — ensuring compliance, fairness, and reimbursement integrity.
With million-dollar claims, AI-based denials, and expanding stop-loss scrutiny, Russo warned that plan sponsors face unprecedented complexity. “It’s not just about cost anymore — it’s about compliance and compassion,” he noted. “Do you really want someone in HR deciding whether their coworker’s child gets care?”
Fiduciary breaches are on the rise, but employers have options: they can build an internal fiduciary committee or partner with experts who can assume the legal responsibility. The key is awareness and action. “You can’t claim ignorance anymore,” Russo said. “But you can choose protection.”
Key Takeaway
Fiduciary duty isn’t just a legal checkbox — it’s a critical layer of protection for employers and employees alike. Understanding, documenting, and transferring that responsibility strategically can help self-funded employers avoid lawsuits, audits, and reputational risk.
Listen and subscribe on your favorite platforms, including YouTube, Apple, Spotify, Amazon Music, iHeartRadio, Pandora, and Pocket Casts, to hear how employers can navigate fiduciary compliance and protect their people in an increasingly complex healthcare landscape.
