Who is TPA?
TPA in Health Insurance : TPAs can be understood as the BPOs, outsourcing the business to the health insurers. As far as the customers of health insurers are considered, the policy holders, TPAs are the most important. Health care system is advancing. Insurance companies are empanelling more and more number of hospitals. With this increases the cashless hospitalization services. Where a health insurance company has different responsibilities, TPAs (Third Party Administrators) are appointed to face the policy holders while a claim has to be made. List of TPA’s (IRDA website)
If you’re ever struck in making a claim in any insurance offices, you would well know about the complex structure and disclosures that have to be made. By its very nature, the coverage of health insurance is very vast and it is at times very difficult to get through all the formalities, especially when you are not well. A TPA is appointed by the insurance company, approved by IRDA to provide claim settlement facilities to the insured.
TPA in Health Insurance
Cashless service:
If you’re hospitalized, cashless service is the most reliable for you. It means that everything liable will be paid directly to the hospital by the insurance company and you need not to shell anything out of your pocket. All these facilities are directly supervised by TPAs and are the one to get informed about claim.
Claim settlement:
Health insurance TPAs are concerned with the claim settlement, right from the intimation of the claim, advising on network hospitals, arrival of claims, to the distribution of the claim.
Maintaining database:
TPAs are provided by all the data from the date the policy is in force. They maintain the data and issue a unique identity card. It is advised to furnish such identity cards within 30 days from the date of taking up of the policy and have it ready in case of any emergency.
Toll Free Number:
TPAs runs 24 hours toll free number and should be accessed from anywhere in the country. It is important to have the list of TPAs and numbers for emergency situations. They also have medical practitioners who immediately advice customers about all the coverable expenses.
Points to ponder:
- It is always the responsibility of insurance company to settle or to repudiate the claims. Thus, in event of any abnormality, policy holder can go against insurance company but not TPAs.
- TPAs take just 2 days to process any claim.
- If insurance company changes its TPA then it’s the responsibility of the company to inform everyone within 30 days.
- TPAs have to send the guide book and related information within 7 days from the issuance of the policy.
- TPAs services are cashless and they don’t charge anything from the policyholder. Policy holder’s premium includes the commission for TPAs in advance.
So, if you’re taking any policy then TPAs are the most important to you then the insurance company itself.
Recommended Read :
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- Why Reimbursement is Better Than Cashless Health Insurance?
- Cashless Hospitalisation not always Cashless
- Insurance without Medical Check - Alert
- Change Health Insurance Provider without Losing Your Credits
- Minor Repairs Claim Vs No Claim Bonus
- How Many Times Can I Claim Car Insurance?
- Vehicle Modification Insurance Rejection
- How to Claim Travel Insurance?
- Role of TPA in Travel Insurance
Another factor to consider when taking out a health insurance policy… Third Party Administrators. It wold be best to check which TPAs are associated with your provider, as well as checking the reputation of your provider. SO much small print, I now know why people just give up and don’t get health insurance at all!
Who exactly appoint the TPA’a? It is the insurance company or the policy holder? The work of TPA is to fasten up the process of cashless service. If the TPA is appointed by the insurance company why does the individual have to shell out a part of his premium to him? The only answer is that because the insurance company is not agreeing to you.