Our WhatsApp number cannot be used for calls. This is a chat only number.
Have you ever heard phrases like “Ask the TPA,” “Get consulted with the TPA,” or “TPA will handle your claim process”? 🤔
If so, you were left wondering, what exactly is a TPA? Who are they, and what role do they play in health insurance? Well, TPA full form stands for Third Party Administrator. It is a pivotal entity that simplifies your health insurance journey by acting as a bridge between you, your insurer, and your hospital.
As you have an insurance company to buy health insurance coverage, the same way, we have a TPA in insurance to fix problems related to health insurance claims. Let’s dive deeper to understand how TPAs make health insurance hassle-free and efficient.
A Third Party Administrator (TPA) is an individual or group that assists in handling claims made under a health insurance policy. They are independent third parties who might help the insurance company settle claims by acting on its behalf. Simply, TPAs serve as a mid-man between the policyholder and the insurance provider.
Over the years, the number of insurers, health policies sold, types of health products and buyers increased in considerable proportion. Ultimately, it got difficult to keep track of work which did not result in quality services. Hence, IRDAI came up with the Third Party Administrators. Since then, a TPA has been held responsible for the following:
A Third Party Administrator will take care of the hospital bills and other expenses. While you are distressed by the illness of a family member or friend, you can just take care of them. The rest will be handled by the TPA.
Every insurance company appoints a TPA for your service. You do not have to pay the administrator directly. A TPA can either approve of a cashless claim settlement or reimburse it later.
For an insured, the connection will always be between them and the insurer only. To summarise, we can put it across that TPA is needed to:
A TPA acts as a support bridge between policyholders, insurers, and healthcare providers. But how they are beneficial for the policyholders, let’s know:
There are two methods used to process and settle health insurance: Cashless Claims and Reimbursement Claims. In these two situations, claim settlement with a TPA in health insurance works as follows:
Third party Administrators of individual or family health insurance plans are linked to certain risk factors. As we have seen, some specific TPA agents have become fraud sources, causing policyholders and insurance companies to suffer financial losses.
Insurance firms must implement certain procedures, such as frequent audits and risk management controls on their TPAs, to stop fraudulent acts in order to mitigate such risks.
A TPA in health insurance must also fundamentally adhere to the legal requirements, keep up-to-date, correct data and provide the best possible customer service.
When it comes to health insurance, understanding whom to reach out to for Third Party Administrator (TPA) service-related issues is crucial. TPAs help streamline the claim process and provide assistance during emergencies. However, you must know the right point of contact for a TPA:
This comprehensive list of health insurance Third-party Administrators was obtained from the official website of the Insurance Regulatory and Development Authority. Please take note that this information is being provided solely for informational purposes. Verification and appropriate caution are recommended.
In the complex world of health insurance, a Third Party Administrator (TPA) is your trusted partner, streamlining processes and ensuring a smooth experience.
From assisting with claims and offering cashless hospitalization to providing expert guidance on selecting the right healthcare providers, TPAs play a vital role in bridging the gap between policyholders and insurers.
Please try one more time!
More articles related to Health Insurance
Disclaimer #1: *Customer can choose options at the time of availing insurance. Premium amount may vary accordingly. Insured is required to disclose any pre-existing condition or on going treatment before policy issuance in the proposal form.
Disclaimer #2: This information is added only for informative purposes and collected from different sources across the Internet. Digit Insurance is not promoting or recommending anything here. Please verify the information before making any decisions.
Get 10+ Exclusive Features only on Digit App
closeRead More
Rated App
Rated App
Scan to Download
