A common term found in all the health insurance policies in India is ‘TPA’. Adding to the confusion is the explanation found “TPA means any company who has obtained license from IRDA to Practice as Third party administrator and is appointed by the company.”
In lay man’s term TPA is like a BPO; a common link between Insurance Company and the Customer. Insurance companies find the processing of claims to be a repetitive and standardized activity and use TPAs to outsource some of their administrative burden for a cost.
Cashless Service is one of the important functions of the TPA india today which means that if you are hospitalized in a hospital among the ones listed by the insurance company, the bill is paid directly by the Insurance Company and you don’t have to shell out anything. But, policyholders find it difficult to avail the cashless Service in a network hospital because there is very less awareness regarding TPAs. Policyholders mostly rely on their health insurance agents who don’t inform them about it.
TPAs health insurance are the ones concerned with dealing with Claims- complete from taking intimations of claims, advising customers on network hospitals, approving cashless and reimbursement claims, to finally disbursing the claims to the customer.
Once the policy has been issued, all the records are passed on to the TPAs and all further communication of the Policyholders is with the TPA health insurance and not with the insurance companies. It is the responsibility of the Third Party Administrator to maintain databases of policyholders and issue them identity cards with unique identification numbers. Policyholders have to make sure that they receive the identity cards from the TPA health insurance within 30 days and have it ready in case of any emergency.
It is essential that you know your TPA list name and contact number since it is the TPA that the Policyholders are supposed to contact in the case of hospitalization or claim settlement.
Toll Free number:
TPAs have to run a 24-hour toll-free number, which can be accessed from anywhere in the country. They have full-time medical practitioners under their employment who will immediately take a decision on whether the ailment is covered under the policy.
Value Added Services:
TPAs also perform some of the additional value-added services to the consumers, like arranging ambulance services, medicines and supplies, guiding policy holders for specialized consultation, and providing information about 24- hour help lines, health facilities, bed availability, organization of lifestyle management and well- being programs.
With the advent of TPA india is the health insurance companies aim at ensuring higher efficiency, standardization of charges, greater awareness and penetration of health insurance to a larger section of the people. There also a trend among the insurance Companies today to terminate the contracts of TPAs and having in- house TPA due to the rising claims and losses.
Whatever may be the case, knowing about your TPA will surely smoothen the process of claim settlement and insurance service.