The relationship between self-insured health plans and third-party administrators (TPAs) is under more scrutiny than ever. As courts raise the bar on fiduciary oversight and regulators close enforcement gaps, employers must work closely with their TPA to ensure compliance.

aequum believes that real protection begins with full transparency and understanding. That’s why we work closely with TPAs and plan sponsors to strengthen legal defensibility, enforce plan terms and ensure that administrative decisions don’t create unintended risk.

Why TPAs Are Under the Microscope

A recent federal court decision has made it clear, plan sponsors must know how their TPAs operate.

In the Sixth Circuit, the case of Tiara Yachts v. Blue Cross Blue Shield of Michigan revealed how administrative decisions can trigger fiduciary liability. The court found that when a TPA exercises discretion over claim payments, reimbursement methods and its own compensation, it is acting as a fiduciary. This could include settling claims with providers if the TPA has a range of settlement authority and does not seek approval from the Plan Sponsor prior to reaching an agreement with the provider. If that discretion is used to benefit the TPA instead of the plan, ERISA liability follows. The Plan Sponsor is not off the hook either. A lack of oversight can be viewed as a breach of fiduciary duty.

What This Means for Employers

These cases reinforce a critical truth, TPAs are not simply service vendors. They operate in a space that often requires fiduciary-level care and compliance discipline. The consequences reach the plan sponsors, and ultimately, the employers, financially, reputationally and legally.

That’s where aequum steps in.

aequum Strengthens the TPA Relationship—Without Sacrificing Oversight

aequum doesn’t replace TPAs. We protect the partnership.

By acting as a legal and claims partner to self-insured plans, aequum supports stronger plan governance, tighter compliance and smarter risk management.

aequum’s role includes:

• Monitoring TPA discretion throughout the post-payment claim negotiation process.
• Ensuring compliance with NSA deadlines and IDR outcomes.
• Supporting TPAs in dispute resolution, shielding both the administrator and the plan from avoidable litigation.
• Providing legal support when provider billing crosses into balance billing, unreasonable charges or potential fiduciary breaches.

From Passive Oversight to Active Defense

The era of “set it and forget it” health plan management is over. Courts are no longer interested in how a plan was supposed to work. They want to know who was watching, who had authority and whether that authority was used responsibly.

aequum helps to ensure that plan sponsors can answer those questions with confidence.

Why It Matters Now

As the industry evolves under pressure, from rising claims, tighter regulations and litigation trends, the relationships that protect the plan are the ones that add real value. Your TPA relationship is only as strong as your oversight.

By working with aequum, employers show that they take plan governance seriously and that their TPA partnership is backed by legal clarity and strategic protection.

The Bottom Line

Every plan sponsor needs more than just a vendor. They need a partner who understands the legal, financial and operational stakes of managing a health plan today.

aequum helps you meet that moment. We protect your plan, support your TPA and deliver the accountability that regulators and courts now expect.

Contact us today to learn how aequum strengthens your relationship with TPAs while reducing your exposure to fiduciary risk and compliance failures.