7 Signs You Need to Break Up with Your Benefits Vendor

By Jeff Yaniga, Chief Revenue Officer

jeff yaniga talks tpa

Breaking up is hard, especially when it comes to a self-funded benefits vendor. It’s like changing your bank—no one wants to go through the hassle. That’s why you get stuck paying ridiculous fees and dealing with awful customer service. This brings me to my point. Sometimes, we just get so used to things being awful that the pain of a break up doesn’t seem worth it. However, when you finally hit your boiling point, that temporary pain of parting ways is worth it in the long run. If you’re considering a break up with your benefits vendor, or TPA, below are seven signs why it may be worth the pain. (Sorry, Cupid.)

1. They’re not flexible to your needs.
I’ve seen this happen a lot to clients who are self-funding through large medical TPAs (also called third party administrators). They’re given rigid plan designs and aren’t willing to work with the unique needs of a company. While this may be the way larger medical TPAs are accustomed to self-funded benefits, this one-size-fits-all approach doesn’t work for most employers today. If you’re in this boat, it may be time to research medical TPA vendors that are flexible enough to personalize their services.

2. Their TPA tech is stuck in the 1980s.
Outdated tech systems seem to be a trend amongst Mom & Pop-style medical TPAs. Their technology lacks depth and isn’t designed with the scalability to meet the needs of larger companies. Luckily, some medical TPAs are upgrading their tech and offering more than just online enrollment like user-friendly mobile apps, data analytics and employee decision support tools.

3. They take all your money.
The cost of employee health and benefits is expected to continue climbing in 2017 – no matter what the future holds for the Affordable Care Act. In fact, it has been predicted that fully-insured companies can expect an 8.2 percent rate increase for 2017. As a result, many companies are calling it quits with their current benefits strategy and moving to a self-funded option as a way to cut costs and increase their plan options.

4. Their idea of customer service breaks your heart.
I can’t tell you how many times I’ve had new clients say to me, “just suck less than the other guys.” Talk about heartbreaking. Of course, they’re referring to their old vendor’s customer service. HR professionals and their employees deserve an empathetic professional to guide them through whatever issue they’re facing. If you do break up with your vendor, don’t accept the same poor service. It’s time to raise your standards – take a look into customer care metrics, like first call resolution rate, and take a look to see if they have their own Client Experience division. Both are signs of a vendor who has their priorities in place.

5. They’re not data smart.
Data analytics are practically a gold mine for HR departments. They can help a business drive down the cost of claims and increase employee engagement. Technology has advanced in self-funding to offer tools available that can flag employees who are exhibiting signs that their health may be at risk, triggering early intervention and eliminating future costly claims.

For example, one of our self-funded clients had a member who was struggling with her diabetes. She was using outdated equipment and her blood sugars were elevated, so one of our Nurse Coaches enrolled her in the Diabetes program, referred her to a dietician and helped her secure new equipment. This helped the employee lose weight and control her diabetes, while also helping the company proactively reduce claims.

6. They don’t seem trustworthy.
I know some HR professionals who have experienced their TPA letting them down so many times that it’s just now an expected occurrence. In fact, they plan for it. They plot out dates when they expect it to happen and strategize how they’ll deal with it. If you’re dealing with this type of vendor-Stockholm syndrome, then you’re long overdue for a break up.

7. They don’t play well with others.
The vendor struggle is real. Managing separate vendors for health plans, benefit accounts and benefits administration can be messy, not to mention put you at risk for errors and gaps in coverage. Modern, all-in platforms can help simplify this nightmare by providing the solutions you need in one easy place for you to manage. You deserve the full package—or at least a vendor and TPA who can customize your own HR suite to include all the automated HR functions you want and need. 

As the wise Dr. Phil says, “you teach people how to treat you.” If any of the above scenarios are hitting too close to home, it may be time to kick that vendor to the curb, and research options that better fit your needs.

Join me on February 22nd at 1:00 pm CT, for an Employee Benefit News webinar I will be moderating – Hottest Trend of 2017: The makeover of self-funded benefits.