Working with Third Party Administrators (TPAs) gives employers transparency and options in their self-funded health plans. In our blog Three Myths of ASOs, we address the many issues that come along with bundling plans. TPAs work on a fee-for-service basis, so you will always know how much you are paying for administrative services. Additionally, TPAs operate independently from insurance companies, which enables you to select the best choices for your team from a variety of vendors. One of the questions that may linger for the HR team, however, is what the healthcare provider network will be like when working with TPAs instead of ASOs. Will the quality of the network be the same?
How TPAs Work
The truth is that TPAs, for lack of loyalty to a certain network, are able to advocate for the client. A close look at their client-centric approach shows that TPAs meet your company’s needs in convenience, cost savings, and quality. TPAs give a company options to build and design a plan that best meets the needs of the organization and its employees, and to have more control over payments.
Selecting a PPO Network
Preferred Provider Organizations (PPO) gives plan participants the flexibility to go to any doctor or facility without a referral. However, by staying within network, participants see significantly greater savings and lower out-of pocket expenses. Participating providers have agreed with an insurer or a TPA to provide healthcare at reduced rates in exchange for member steerage and elevated payment terms. A TPA’s value comes in helping companies select which PPO network to join. Multiplan, PCHS and First Health are some of the largest national physician PPO networks. There are also regional PPO networks, such as Midlands Choice in the central states. In a few instances TPAs will also offer their own proprietary network. The ultimate goal behind any of these networks is to provide affordable quality healthcare to employers and their employees. Also, you should note that doctors and facilities can and do belong to multiple networks including large insurance company networks, as well as national and regional PPOs.
Learn more in our whitepaper Selecting Provider Networks.