Why should health policyholders seek the service of Third Party Administrators?
Third Party Administrator is popularly known as TPA in India. This is essentially an agency which functions on behalf of an insurance company and gets involved in direct communicates with the policyholders. These agencies focus on resolving claims for cashless hospitalization. Almost all health insurance establishments in India resort to various TPAs to perform their claim settling processes with a few exceptions like Star Health and Max Bupa as these insurers choose to operate directly with their policyholders.
Why do policy holders need to know about their TPA?
- The first and foremost reason is insured people need to submit requests for cashless treatment to these TPAs. These agencies decide whether they would grant they request and let them avail cashless treatment facility.
- Secondly, people with valid health insurance plans, are usually provided with a list of network hospitals to choose from for availing cashless treatment. To gain information on these network hospital policy holders need to get in touch with their respective TPAs. Insured people can look for the name of their TPAs in their policy documents. To know about the panel of network hospital, they can visit their portals or call them up.
- Aside from cashless claims these agencies also settle reimbursement claims.
TPAs have a widespread presence in the domain of health insurance. These agencies are considered as the call center of insurance companies.
TPAs typically keeps all the data and medical records of insured people and they start working on claim applications keeping policy guidelines into account on request.
TPAs are also armed with a pool of medical practitioners to affirm whether the hospitalization is really a necessity or not.
How should insured people deal with TPAs?
A majority of the claim applications gets rejected by TPA because applicants are not aware of the right ways of dealing with TPAs. Here is the right way of working with them.
The very first thing that insured people must do is to inform their respective TPAs about the hospitalization of themselves or their family members. The hospitalization can be either planned or due to an emergency.
In order to get a claim request approved insured people need to submit the following;
- Name of admitted patient
- Policy number
- Policy holder’s ID number
- Reason behind hospitalization
- Doctor’s name
- Hospital’s name
- Documents that support ongoing medical treatment such as test reports, prescriptions.
How does the cost of a TPA covered?
Policy holders pay for the costs of a TPA when they pay the premium for their health policies. In other words, insurance firms get paid by insured people to provide TPA facility. However, this facility is not a mandatory requirement to avail a health plan. There are some insurance houses in India in the likes of Oriental Insurance that offer discounts on premium if policy buyers don’t go for a TPA facility.
It can be an uphill task to have claim applications approved directly from an insurance company. Insured people, more often than not, have to make several calls, wait for months to have their medical expenses reimbursed. This is why people with health covers are better off getting in touch with a quality TPA agency to have their claims accepted fast and without much hassle.
