Understanding Third-Party Administrators (TPAs) in Healthcare Insurance

In today's video, we dive into the world of Third-Party Administrators, commonly known as TPAs, in healthcare insurance. If you've ever been puzzled by your insurance card saying one thing but having to deal with another company for claims and administrative matters, you're not alone. TPAs play a significant role in managing insurance plans for big employers and self-insured companies.

Join us as we unravel the complexities, discuss their benefits, and provide insights into navigating this aspect of the healthcare industry.

If you have questions or experiences with TPAs, please share them in the comments, and don't forget to like, subscribe, and share this video with your fellow healthcare professionals. Healthcare can be challenging, but we can make it a bit clearer together. Stay informed and take care!

Hi there! My name is Jennifer. Over the last 15 years, I've gained much experience working in the medical field in various roles. Through my experience, I've seen many medical practice owners make mistakes in running their businesses. That's why I created this channel - to help medical practice owners avoid these common pitfalls. I aim to promote growth and success within the private practice world of medicine. I believe healthcare has become too institutionalized, creating many unnecessary challenges and demands.

License code: B7WEBREUQSOFDFJ3

[dgrnfod]

Really appreciate this! My company just got into the TPA business via merger, and most of us have no idea how this world works. Appreciate you, thanks again!

[itsirkeel]

I'm THRILLED that you created this video on this topic! I think what would be helpful for an additional possible deep dive on this is: How to explain TPAs to a patient when they don't have a clue about them. I think especially about ASH, American Specialty Health, and 'Cigna/Trustmark/enter company here' plans because ASH is in NO WAY customer-facing, so the patient doesn't have a chance of reaching the people who are actually processing their claims. CHP at least the patients receive EOBs directly from them, or so the CHP rep told me this morning. I have no idea what our 'Cigna' patients receive because I route everything through ASH. Do you have suggestions on explaining to a patient, "I know your card says 'xyzabc' but actually, they aren't doing anything with your plan"?? So grateful for all of your insights!!

[ARamilful]

It is so helpful and informative video. Thanks so much for creating this one. I am a software engineer and I am working on automation process of TPA eligibility. I am looking for a standard eligibility questionnaire template. How I can find it?

[worldbeauty]

good to watch your videos, can you assist me regarding the BCBS TPA in newyork which TPA has BCBS in newyork to negotiate the self funded claims

[Kethy-npbv]

Hi, I just want to know the card to pay for example a new patient in pharmacy and was prescribed medicine, what kind of a prescription insurance card she will use? Thank you.