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Kimberly Carleson
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Oct 21, 2026
The One Question to Test if a TPA Is Actually Independent, With Kimberly Carleson
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2:25Stacey RichterHOST
Is there one kind of like one question to rule them all, one tell to rule them all? Like, how do you how would you assess whether it's the CPA is like independent or whether the CPA may have may find themselves running up against other interests?

Kimberly CarlesonGUEST
I think the one way to tell is you ask them one question and you say, can we have someone come in and independently review our claims? If they say we have network contracts that restrict that, then you know that is a red flag and they are not truly independent.

Kimberly CarlesonGUEST
So the one way to tell is, are they gonna allow independence? on review for the claims.

Kimberly CarlesonGUEST
Are they gonna allow you all the data? Are they gonna allow you your billed, your paid, and your allowed charges? Are they gonna allow you to see all the claims data? Those are things that if they have any hesitation on, you know they are not truly independent.
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5:39Stacey RichterHOST
That's a really good tell that the TPA may not be quite as independent as you may like as a plan sponsor who's trying to figure out how to create your own self-funded plan.
How Overbilling in Healthcare Sparked a Mission to Fix the System
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Kimberly CarlesonGUEST
So my husband was diagnosed with stage four cancer and I was pregnant with my son at the time.

Kimberly CarlesonGUEST
I was told, Kim, he's got a good two years while I was four months pregnant.

Kimberly CarlesonGUEST
And I looked at that doctor and fired him and I went and found one on my team.

Kimberly CarlesonGUEST
I started realizing how health care was run because we were part of the system at the time.

Kimberly CarlesonGUEST
Once I realized how much overbilling there was, I told my husband I wanted to buy 100% of it.
6 MINS LATER
