We have full-time Kempton Premier Provider™ staff who are willing and able to assist you. Please visit our contact page to reach out to us, and we will get back to you right away.
Prospective Kempton Premier Providers™
We have compiled a list of frequently asked questions to address any questions you may have as a prospective provider. Please read the section(s) that apply to you below.
Information for All Providers (read first)
Who is The Kempton Group?
The Kempton Group Administrators (KGA) is a Third Party Administrator of self-funded employee benefit plans. To learn more about the Kempton Group, please visit our website at www.kemptongroup.com.
Why is Kempton interested in the Free Market in healthcare?
Healthcare transparency provides consumers with the information and the incentive to choose healthcare providers based on value. Value is not just about price; but rather price and quality. Providing reliable cost and quality information empowers consumer choice.
Because all of our clients are self-funded (What is Self-Funding?), consumer value is very important to the success of their Plan and to the success of their business.
The evidence that free-market, transparent healthcare works is proven by looking at the dollars saved. When consumers become aware that high value healthcare is far less costly, they begin to change the way they perceive their healthcare buying decisions. Healthcare services can and should be viewed just like any other purchase we make—based on VALUE, which includes both quality AND price.
What is Self-Funding?
Self-funding, or self-insuring, means that employers take on the risk of their employees’ claims expenses. This means that most pay their employee claims out of their operating budget. A self-funded plan is 100% funded by either the employer or the employee or a combination of both. This means that every dollar saved directly benefits your community employer and/or the employee. More than 60% of employee benefits in the US are paid by a self-funded benefit plan. To learn more about self-funding, please visit the Education section of www.kemptongroup.com.
What is a Third Party Administrator?
A Third Party Administrator (TPA) processes the claims and helps manage the benefit Plan for a self-funded employer. A TPA’s responsibilities include maintaining eligibility, adjudicating and paying claims, client customer service, provider customer service, utilization management, etc., plus arranging for services such as stop loss coverage, provider network access, a pharmacy benefit management company, and case management. A TPA also assists the employer with employee education.
There is more than one kind of TPA and this makes a huge difference in how a self-funded employer can respond to an independent physician or free market facility.
Are there different kinds of Third Party Administrators (TPAs)? Why is this important to me?
YES! Not all TPA’s are created equal. There are three types of TPAs. The type of TPA an employer has hired drastically alters how a self-funded employer is able to interact with a provider.
Independent (like Kempton)
ASO (Blue Cross, United, Cigna, Aetna, etc.)
Hybrid (uses a carrier PPO/network)
If an insurance carrier is the TPA or owns the PPO Network utilized, the employer will have LITTLE TO NO CONTROL over their Plan and it will be difficult for them to work directly with you. Even some independent TPA’s aren’t as free-market minded as The Kempton Group.
The presentation by Jay Kempton at the AAPS conference in January 2015 outlines the various types of TPA’s and how they affect how a self-funded employer is able to work with you.
The buying and selling of goods and services is more stable in a free market. The exchanges in a free market are mutually beneficial to all parties. Any other arrangement begs for at least one party, and sometimes both parties, to be injured.
A free market is conducive to competition which benefits the consumer in terms of both price and quality. Whenever the consumer has been disenfranchised in any industry, quality suffers, prices soar and what goods and services are provided are determined from the top down, rarely if ever having any relationship to what the consumers actually need (and want).
Physicians operating in a free market environment find happier patients, none of whom feel as if they are being pressured to see a particular doctor, but rather exercising their choice. This provides for a healthier patient-physician relationship, fewer bureaucratic hassles, typically better pay and better outcomes.
How do I reach self-funded employers?
Who are the mid-size to larger employers in your area? It is very likely that they are self-funded. Do you have a 150 life manufacturer? How about a 500 life electrical cooperative? Contact these employers and find out if you can work with them in a mutually beneficial way to provide great care at a great price to their employees. Talk to their Third-Party Administrator (TPA) or contact local TPAs in the region about direct contracts to benefit your local community employers.
Is there a glossary of terms that can help me understand insurance and self-funding?
Yes! To review a list of employee benefit plan terms and definitions, please click here (PDF).
I am a Surgeon, Surgery Center, Hospital, or Imaging Provider
I want to become a Premier Provider and offer bundled cash pricing. How do I do that?
That’s great! Deciding you want to become part of the free market and offer transparent up front pricing is the first step in becoming a Kempton Premier Provider! Make sure to contact us to start the process, but below is a brief overview of how the process works.
The next step is to decide which procedures you would like to see more of in your business. Which procedures are your providers and surgeons the best at, and which things can you do in the most efficient way with the best quality outcomes? Those procedures and surgeries are the best to offer under a bundled cash deal.
Once you have decided which procedures you want to offer, you have to decide on your bundled price. This price must bundled, which means it has to include all components, including facility charges, surgeon fees, and anesthesia. Many of our providers have chosen to also include a ‘warranty’ or guarantee as well. You may want to peruse the pricing of similar providers on our website to see what your market competition is choosing to charge for similar services.
Remember, our employers are choosing to waive ALL OUT-OF-POCKET expenses for their employees and pay you quickly and at 100% when their employee chooses to use a Kempton Premier Provider. They do this because of the VALUE being provided, which includes cost and quality. If your pricing is not competitive, we may not be able to offer your services as KPP services. This is why we encourage you to pick your best procedures that you can perform in the most efficient and highest quality way.
After choosing your procedures and setting your bundled pricing, you will send both to our team to review.
Once your procedures and pricing are reviewed and accepted, we will provide you with a very brief payment agreement to sign and then you are a KPP! We will work with you to educate your staff and start promoting you to your future patients!
I am a Direct Primary Care Physician
Learn more about how a DPC can work with Self-Funded Employers
Why would I, as a direct primary care physician, want to reach out to self-funded employers? Click here to read the article (PDF).
Answered by: Jeff Davenport, M.D., One Focus Medical
I am interested in the Free Market Medical Association (FMMA)
What is the Free Market Medical Association?
The FMMA is dedicated to bringing together physicians, patients, and self-funded employers to further promote transparency. The FMMA provides resources to promote a successful industry while defending the practice of free market medicine without the intervention of government or other third parties who seek to make healthcare opaque. To learn more, visit the FMMA website www.marketmedicine.org
How is The Kempton Group affiliated with the FMMA?
YES! Currently the local chapter (serving OK, KS, TX and surrounding areas) of the FMMA meets on the second Thursday of every month with an occasional additional event. If you are interested in attending a meeting or other event of the local chapter of the FMMA, we’d love to see you! For time and location details, please use our Contact Us form.