Beware of the TPA or THIRD PARTY ADMINISTRATOR. More and more insurance companies are hiring these companies to administer or review their claims. BE CAREFUL! Their main goal is to reduce all or part of a payment on a claim. Some companies like "REPRICING INCORPORATED" do exactly what their name implies. The insurance companies send them every claim, and they automatically down code them. Meaning you may have out of pocket expenses that should have been covered under your insurance or health plan. They are probably the most dangerous entity to the health care consumer because they are chameleons. They may appear to be friendly at first but can change into something quite ugly. They are also veiled under different names and cloaked in secrecy. They have many functions and are quite elusive. For example, there are employees who review your personal health information and make decisions which may adversely effect your benefits ...even your health. Many times, you are not allowed to know who these people are or what credentials they have. For example, this author has even had employees of these companies claim they are nurses only to find out they had a three day course in billing codes.
What is so scary is that they are not even licensed or even regulated in any state. Furthermore, there is no centralized data base to monitor where these organizations are domiciled. States are supposed to regulate the insurance campanies, but they have no control over these TPA's.
There was a recent case where the third party administrator send false information to a state bureaucracy convincing that state to prosecute a policy holder while the policy holder had already sued them and the insurance campy in federal court! It is absolutely frightening to what lengths insurance companies and their third party administrators will resort to decrease payment on benefits while increasing their profits from your premiums. Remarkably,in some cases, they are supported by the government in this behavior!
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