“For the lion’s share of claims, the TPA is still leasing a large carrier network in order to secure the negotiated discounts with doctors and hospitals. But … there are some services for which the carrier’s network rates are egregiously high — and for those services the TPA will simply apply Medicare reimbursement levels instead….”
The projected impact of carving out administration to this more aggressive TPA would purportedly save clients in similar networks 4‑8% on total claims spend.”
Frenkel Benefits
Handling Health Claims: Traditional Carriers vs. TPAs
