Beware of the Fine Print
There’s a troubling trend among large administrators to prevent plan sponsors from effectively auditing their claims adjudication. Unfortunately, audits are one of only a few ways employers can hold TPAs and PBMs accountable for applying reasonable claim controls. After all, if they win new business by having broad networks, lower discounts, and lower fees, the easiest way to prop up that facade is to automatically pay almost every claim submitted by providers. (more…)
