While attending a conference last year, I engaged in conversation with a benefits manager from a large company. I pointed out that Healthcare Horizons could find not only current savings for his company, but possibly future savings. I also reminded him that a self-insured employer has a duty of care as fiduciary of their plan to protect their stakeholders, including monitoring the healthcare claims payments made by their TPA. I was rather surprised by the response I got:
“We don’t need an audit, our TPA has us covered. They look at all that for us, and we don’t need to worry about it.”
Unfortunately, that is not the case. While claims payers generally do a good job on behalf of their clients, people make mistakes. Healthcare Horizons has recovered more than $250 million in overpaid healthcare claims. Mistakes can add up over time and the loss can be significant. It is crucial that self-insured employers conduct annual healthcare claims audits because one of the unintended consequences of self-insuring is that claims payers have no financial incentive to control medical costs.
At Healthcare Horizons, our top priority is to protect our clients’ financial interests by ensuring that their medical claims payments are being paid as accurately as possible. So when you say, “Our TPA has us covered” – are you sure?
Errors Happen. People Are Not Perfect.
To learn more about our approach to healthcare claims auditing or out-of-network provider fee negotiation services, visit Healthcare Horizons, or reach out to us at hhadmin@healthcarehorizons.com.
Randy King is president of Healthcare Horizons Consulting Group, Inc. The company is one of the nation’s leading healthcare claims auditing firms, focused exclusively on self-insured employers since 1999. Healthcare Horizons has recovered millions of dollars for its clients through auditing and air ambulance negotiations for some of the world’s largest employers.
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