Looking at the vital role a TPA plays in the health insurance field

We all know how important a health insurance policy can really be. Everyone needs financial protection from hospitalisation expenses, and this is where your policy does just that. But while most of us are well-versed with health insurance policies, not many are aware of a Third-Party Administrator (TPA).

Doesn’t ring a bell? Let us go through details regarding the role of a TPA in detail for you to gain a better understanding:

What exactly is a TPA?

A Third-Party Administrator is an organisation that processes the insurance claims you make under your health insurance policy. Usually, these administrators, which are licensed by insurance regulatory IRDAI, work independently. However, they can also function as an insurance company’s entity.

Role of a TPA

  1. Ensuring a smooth claims process and settlement

A TPA is tasked with the responsibility of settling your claim as soon as you inform them. They will then check all of the documents that you have submitted while making the claim. The TPA can also inquire about information that they would need to verify all the details. If you have opted for cashless treatment, the TPA can get all the documents from the hospital directly. If you are going to get reimbursed, the TPA can ask you for all documents and bills that they need.

  1. Issuing health cards to policyholders

A validation procedure is carried out for each insurance policy that is issued to a policyholder. This is done by issuing an authorised health card. This health card will include details of the TPA who will be in charge of processing claims as well as the policy number of an insurance plan.

  1. Providing assistance with insurance claims and policies

While filing for a claim, it is quite natural for you to have questions in mind regarding your insurance policy. All of these questions will be answered by the TPA. These administrators often provide 24/7 customer service where they can be contacted from anywhere in India.

  1. Strengthening the hospital network

This is one of the biggest benefits of having a TPA mentioned in your health insurance plan.  This is because the TPA is tasked with enlisting hospitals that can immediately arrange for cashless treatment, making the entire process of hospitalisation much easier.

So, how does a TPA help you?

A TPA acts as an intermediary between an insurer and policyholder. Their main focus is to ensure the claims procedure is completed without any complications. If you are hospitalised for more than 24 hours, you can make a claim through your health insurance policy. You will have to intimate the insurer or the TPA about the medical treatment you have to undergo. The TPA then communicates with the hospital and inquires about cashless treatment. Once the treatment is done, the hospital will send all your bills to the TPA for verification. After all the documents are checked by the TPA, the payment will be made to the hospital. In case of reimbursement, the insurer will then transfer the money to you.

We hope that this article has been a good read.

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