Third Party Adminstrator as a concept was introduced by Insurance Regulatory and Development Authority with the aim of providing fair and fast claim settlement to the customers in the fast growing health insurance industry.
A TPA acts as a bridge that connects insurer, provider (hospital) and the consumer by facilitating claim settlement in tune with the policy terms and conditions as well as arranging cashless hospitalisations through agreements with providers.
Cashless facility has been increasingly utilised by the customers as it obviates the need for worrying about making payment to the hospital, instead of focusing on getting back to shape.
The TPA also would have entered into agreements to treat the members through preferred admission process. This again ensures there is less to be concerned about in the process of hospitalisation for the member.
As a professional claim manager, the TPA is able to bring in efficiency into the system, reduce claim processing effort to the insurance company and indirectly reducing the cost of health insurance to the customer.
The TPA achieves this by having professional claim processors lead by medical practitioners and customer service people who liaise with the customers through the claim process. Though the TPAs have medically qualified people, it is not customary for them to advice the customer on the line of treatment, which is best left to a medical professional who can examine the member physically.
The member also has the choice the hospitals to get treated though cashless facility will be available only from the empanelled network. It is also advisable for the customer to read through his insurance policy just to make sure that there are no restrictions on using a particular system of medicine or a provider as far as the insurance is concerned.
Technology plays an increasing role as the TPAs in India have to manage enormous amount of customer information and provide access to the various stakeholders. Members of a TPA usually carry an ID card that provides identification and the membership number. This card is useful enough to carry for the member.
TPAs have served the health insurance industry in the past seven years by substantially improving customer service and professiobalising claim management. With a TPA behind you, your mind can leave behind anxiety of what if…