Medical Bill A TPA sent the claim to its parent company, which repriced the claim, and the TPA administered payment to the provider. No one thought twice about it. (Photo: Shutterstock)

A third-party administrator (TPA) client of ours, and its client (a self-funded health plan governed by state law rather than by ERISA) recently finalized what turned out to be a year-long arbitration process.

This particular TPA is owned by a large insurer. The TPA itself is “independent” in the sense that it’s not an ASO, and has relative freedom to administer benefits as it pleases, but it is nonetheless closely tied to the insurer’s behemoth of a network, and its groups therefore incur very few out-of-network claims. This, of course, reduces member noise to a negligible level, which is ideal, but the network rates are always arbitrary, and often the discounts are small (but that’s another story for another day).

Complete your profile to continue reading and get FREE access to, part of your ALM digital membership.

Your access to unlimited content isn’t changing.
Once you are an ALM digital member, you’ll receive:

  • Critical information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and events.
  • Access to other award-winning ALM websites including and

Already have an account?



Join BenefitsPRO

Don’t miss crucial news and insights you need to navigate the shifting employee benefits industry. Join now!

  • Unlimited access to - your roadmap to thriving in a disrupted environment
  • Access to other award-winning ALM websites including and
  • Exclusive discounts on and ALM events.

Already have an account? Sign In Now
Join BenefitsPRO

Copyright © 2023 ALM Global, LLC. All Rights Reserved.