Plan Sponsors Beware! Are You Next?

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Mike Flores

“According to industry experts, more and more CEO’s, CFO’s and Plan Administrators are exposed to tremendous liabilities due to poorly managed or “Head in the Sand” monitoring practices. As we have written about and predicted, this is evidence of the growing trend of self-insured health plans being exposed to tremendous liability by TPA’s.”

“These cases also illustrate an ironic twist, in many cases, the ASO agreements prohibit the plan from auditing the claims that the TPA’s are paying on behalf of the self-insured plan, which on its face, seems to be a remarkably absurd clause that any plan sponsor would agree to sign.”

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TPAs Developing Innovative Strategies To Control Health Care Costs

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KGA has identified providers that offer transparent, greatly-reduced, all-inclusive cash prices. These providers allow KGA to utilize this pricing because the claims are paid quickly and at 100%. Plan participants utilizing a Kempton Premier Provider for a covered medical procedure benefit by incurring no out-of-pocket costs and the plan receives substantial savings. It’s a “win-win” for all parties involved.

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