Pissed Off Plan Sponsor Has Had Enough!

Pissed off plan sponsor has had enough! Their TPA has not lived up to expectations and a warning shot has been fired across the TPA’s bow……………

Email from plan sponsor to TPA sent yesterday (with a copy to RiskManagers):

We have been trying to update our letter of agreement that is sent to out to providers.  We started the process in APRIL 2021 and have not resolved it.  We wanted to change our contracted rate just for the IV medication that is given in the contracted provider’s office.

We have a new letter now (July I think) and I know Mary was working on a contract for (NAME OF PROVIDER) and she was going to move forward with it. However, there was still work being done on the back ground on how claims would be processed. As far as I know this is still not resolved and we are now at Sept 2021. I have followed up so many times to keep this moving yet never get feedback on issues or where we are I the process. It seems like if I don’t follow up then nothing is happening.  I am very tired of having to follow up and not getting prompt relies in reasonable amount of time.

I sent a request on 8/11 for a revised SB&C. The only thing that needed to be changed was the dates. I haven’t received it back yet. I would not expect it to take a month with only the date needing to be changed. It is my understanding that we should be providing the SB&C 30 days priors to the plan starting.  However, we have never received the SB&C in that time frame. I will say that some years that may be due to us making last minute changes, but still I don’t think I ever get the SB&C before 10/1 plan start date. I hope this never comes up in an audit.

There have been a lot of issues this last plan year. It now seems to take a long time to get any changes made and to get information back. I have to follow up multiple times on requests for information.  We do intend to shop TPAs for 10-1-2022 plan year.  We need to see a big difference in the next 8 months to stay with (NAME OF TPA).