Finding the Best Insurance Rates

Most of the time the “big five” insurance giants will use their TPA and then use their parent company as the reinsurer. Consequently, self funded plans lose one of their strongest benefits of having a self funded plan because these corporations do not shop around for the best reinsurance rates. Furthermore, their loyalty is to their parent company and to their network of providers because they have already made commitments to the hospitals and other providers to give them control over the payment of claims. What this means to you — the self-funded client — is that you lose the ability to control your own cash flow and you typically pay way more than you should. For example, we frequently see a contract where a TPA is not just using their parent company for reinsurance but they are also excessively charging items that should be passed on as savings to you. A good example is on the prescription drug side where they may be taking a fee for a Pharmacy Benefit Management Company even though that is a cost-savings function that should be passed on to the client.

We also frequently see utilization review charges that have no limit and charge 20–30% of the savings whereas our negotiated utilization review will save the client more by charging them only 15% of savings with a $5,000 limit on any claim.

In an era with skyrocketing healthcare costs and highly complex and numerous financial angles that comprise the entirety of the Health Benefit Plan, it has become essential for businesses who are self-funded or should become self-funded to partner with a Broker and TPA whose loyalty is 100% aligned with the client rather than parent companies, pre-existing contracts with hospitals/providers, or the shareholders who affect their quarterly stock price.

FirstNation Health

We are a licensed Third Party Administrator and brokerage firm established in response to the needs of the Native American business community to better understand the complex financial angles of a Healthcare Benefit Plan.

Get in Touch