Florida Insurance Question

My company (Self-Insured) recently switched from running their own TPA to using an external one this year and it has caused nothing but issues. Understand that my employee is a Health Care company in and of itself so has access to doctors, labs, hospitals, pharmacies, etc. They give us significantly discounted rates for using their in-house providers.

One issue that has recently come to light is that a lot of employees were getting billed for lab work even though we were using our companies labs. This was always covered in the past without issue, but this year was different. At first and for the last 6 months or so we have been told it is just billing errors while they work out the new insurance correctly and it would all be fixed. In a recent meeting however the explanation was changed.

We were told the issue is that sometimes our lab gets too busy, and when this occurs our labs will send overflow to other labs in the area they work with. Unfortunately the way the new insurance was setup these other labs are not covered and thus we are getting the bills as though they are out of network providers. They admit they use several and have no way to guarantee what labs the might send stuff to if they do not have the capacity in house. They admit there is no way for them or our labs to provide any pricing up front due to this as they again have no idea where it it might be sent of if they will do it in house and thus we were more or less warned if you get lab work, you might get really big bills, just now way to know for sure.