Does anyone have TPA of Georgia as your insurance?

Question

I'm trying to get approved for the lap band procedure. My husband works for a company that is self-insured but they use TPA of Georgia to give approvals and handle claims, etc. They are really giving me the runaround on everything from paying claims to approving the lap band surgery. I meet all the criteria.

Answer 1

TPA means Third Party Administrator. It's NOT an insurance company - it's a third party, who looks at the procedure, and if it falls within their coverage guidelines, they write the check.

They aren't the ones paying the claim - it's the company that's self-insured that's ACTUALLY paying the claims, and that ACTUALLY has to approve it.

Clearly, this procedure is NOT within the authority guidelines for the TPA to write the check - your husband will have to go through the HR department at his company to do this.