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The PBA Advantage

All TPAs are not created equal. At PBA, we exist to improve outcomes for our clients. To help them save money, while still taking care of their most important asset, their employees. Our guiding principle starts with putting Member Advocacy first and everything we do enforces this principle.

Flexible Plan Design

Since self-funding allows maximum flexibility, plan design is an ongoing process. PBA begins the process by reviewing the current plan of benefits and previous claims experience. Once we understand where your healthcare dollars have gone, we recommend prudent steps. Based on experience and plan modeling tools, we help modify the plan as the needs of your group and market conditions change. PBA provides a level of freedom and flexibility simply not available with a traditional fully insured plan.

Outstanding Member Advocacy

Our domestic call center has live Member Advocates answering all phone calls within an average of 20 seconds. We don't trap callers in an endless phone carousel system. We understand that when employees call with problems they are often anxious for a resolution. Our Member Advocacy team provides reassurance and answers providing peace of mind. Likewise, our dedicated account team assigned to each employer group is supported by associates with an average of 20 years of industry experience.

Medical Management

As healthcare delivery continues to evolve, we have implemented appropriate cost, utilization and condition management strategies. Patients with chronic conditions get the care they need and clients are better prepared to find a balance between cost control and employee satisfaction.

  • With strong pre-certification, utilization review, and care coordination programs, provider discounting becomes less relevant
  • Predictive modeling helps identify and manage chronic conditions while early intervention and education help reduce long-term costs
  • Specialty condition management programs like cancer, transplant, and dialysis control the cost of these high claims

Plan Management

PBA provides clients with totally integrated administration and our industry’s most advanced benefit technology. We use our systems to implement and manage self-funded and consumer directed health benefit programs, eligibility and claims administration.

Integrated Cost Management Features

  • Bill review and out-of-network provider discounting
  • Proactive identification of subrogation opportunities
  • Pre-emptively manage plan member eligibility
  • Application of stringent adjudication controls and edits