Finance

Explaining the role of TPA in health insurance.

Health insurance can be a real saviour in case of a medical emergency! A good policy will ensure you never have to worry about the cost of treatment and that you focus fully on getting better. You just get to a cashless hospital that is covered under your policy and everything is taken care of for you. But have ever stopped to wonder how things are so streamlined and simple?

Well, a lot of credit for the seamless experience goes to Third Party Administrators, or TPAs as they are better known. This article will explain what TPAs are and tell you what their role is in health insurance. Read on to know more!

So, what are TPAs?

TPAs are IRDAI authorised bodies that act as intermediaries between you and your insurance company. They provide a host of services on behalf of your insurance provider and ensure you have a smooth claim process.

Claims assistance:

Topping the list of important things that a TPA does is claim assistance. In case of a cashless claim, all you need to do is inform the TPA at the hospital desk and give them with the details of your health policy. After intimation, it is the TPA’s job to approve your claim based on the coverage and exclusions of your plan. When you are discharged, the TPA will collect all the billing information from the hospital desk, evaluate the policy details, and accordingly pass the claim.

Issuance of health cards:

It goes without saying that the TPA plays an integral role in the entire claim process. One of their jobs is to create and maintain a database to collate all the details & documents of the policyholders. Besides this, the Third-Party Administrator is also responsible for the issuance of health cards to the insured. These health cards are important and must be shown to the hospital authorities to avail of cashless services.

Assistance in case of a rejected claim.

There is always a chance of claims being denied. However, if you have grounds for appeal, you can get in touch with a TPA for help. All you need to do is call them up and then email them the details of your case. They will evaluate your information and provide you with guidance on the steps that must be taken to reapply for your claim.

Help & guidance:

Besides claim assistance, you can also reach out to a TPA for general health insurance help and assistance. Many TPAs even have toll-free numbers allowing you to contact from anywhere in India. They provide expert advice & guidance to policyholders for free! If you need to find a TPA near you or their contact details, you can simply visit the IRDAI’s website and you should find the information there!

So, as you can see, TPAs are an important support system of insurance companies & policyholders. They ensure smooth, hassle-free, and quick procedures in times of need. We hope this has been helpful, good luck and all the best!

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