Self-funded health plan fiduciaries should routinely review large health insurance claims (aka, bills) and ask questions. Their attempts to do so, however, are often thwarted by third party administrators (TPAs) or networks who assert that plan fiduciaries don’t have the right to “audit” claims. TPAs and networks will point-blank refuse to share the data necessary to review claims, either pre-payment or post-payment.
The TPAs and networks are wrong.
