Who pays the extra charges when a TPA fails to scrutinize medical bills and ensure compliance with the plan specifications and acceptable medical billing regulations?
> The self-insured organization and the enrolled employees do. It’s hard enough to pay the ever-increasing costs of employee health care coverage without wasting money paying for medical bills that aren’t yours. If the organization assumes the extra costs, it hurts the bottom line. If the cost increases are shifted to the employees it hurts morale and retention. Soon the healthy participants start dropping out of the plan, leaving the sick employees to accelerate future cost increases. Before you know it the health insurance plan is in an irreversible downward spiral of adverse selection.
Related Questions
- Who pays the extra charges when a TPA fails to scrutinize medical bills and ensure compliance with the plan specifications and acceptable medical billing regulations?
- How is the information secured, especially in a medical setting to ensure HIPAA compliance?
- Can I be liable for any extra charges pertaining to the horse i.e. vet bills?
