TPA is the abbreviation for Third-Party Administrator, which is an agency or an organisation that holds a registered license from the Insurance Regulatory and Development Authority of India (IRDAI) and handles some of the most important aspects of health insurance by working as intermediates between an insurance company and the insured. The third-party administrator is an outsourced entity which helps the policyholder in providing a claim within the timeframe and also assists in other activities on behalf of the insurance company. In this article, we’ll delve into how TPAs function, TPA claims processing, cashless TPA and much more.
Functioning of TPAs
Here’s how TPAs function in the case of cashless treatment:
- Once a policyholder or an insured person files a claim, the TPA assist in speeding up the claim process, gathers all the information related to the hospitalisation of the individual and verifies the claim mentioned to meet the terms and conditions of the policy.
- The TPA helps the policyholder to get admitted to the network hospital for the best treatment and helps to avail of cashless treatment.
- The collaboration between the policyholder and the hospital is important in a Cashless Claims process since the bill is settled directly between these two parties and the TPA claims offers back-end support in such situations to speed up the process.
This is how TPAs function in case of reimbursement treatment
If the policyholder does not take the treatment from the networked hospital, then the policyholder will have to pay the bills out of their own pocket, and later, the TPA will assist the policyholder and apply for reimbursement from that non-networked hospital. The TPA will issue an authorization letter to the hospital, which will allow the hospital to track the case and check the medical history of the patient. The TPA insurance claims mention all the possible treatments that the policyholder is liable for and the TPA later coordinate with the hospital management team to keep track of treatment and reimburse all the bills that are covered in the policy.
Conclusion
TPAs are an integral part of health insurance companies that help a policyholder take care of the family during treatment in peace. The TPA also ensures that its customers have access to the highest quality of service and better financial support for you and your family in medical emergencies. One should invest in family health insurance and hire TPA to get their health insurance claims efficiently and effectively with full coverage. TPA ensures good networking with hospitals and provides hassle-free services to their clients.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.