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What Is TPA (Third Party Administrator)?

Third-Party Administrators (TPA's) are IRDA approved organizations or entity that facilitates settlement of claims. Usually, Government Insurance companies outsource their claim settlement tasks to these specialized firms. They facilitate the entire claim management task.

In case we are not happy with the claims settlement process then we can always challenge the TPA's keeping IRDA in the loop. The entire process is elaborated step by step in subsequent paragraphs. In the case of private firms, there is an in-house team for claim settlement. To begin with, we should know the list of companies and contact details of people who are working as TPA’s.What is TPA?

Some of the Latest Details As Fetched From IRDA Site Is As Follows

Sr. No Name of TPA Contact Person Contact details Email
1 Medi Assist Insurance TPA Ganesh k 080-49698036 ganeshk[@]mediassistindia[dot]com
2 Paramount Health Services Suresh Karandikhar 020-25300000 Skarandikar[@]mdindia[dot]com
3 Emeditek Insurance TPA Limited Dr. Dheeraj Kumar 0124-4466600 drdhiraj.singh[@]emeditek[dot]com
4 Heritage Health Insurance TPA Limited Surendra Kumar Tiwari 033-22482784/22486430 stiwari[@]bajoria[dot]in
5 United Health Care Parekh Insurance Shiva Belawadi 022-28532400 shiva.belavadi[@]uhcpindia[dot]com
6 Medicare Insurance TPA Services Dipankar Roy 9831184120/033-22812826 medicareho[@]medicaretpa[dot]co[dot]in
7 Raksha Health Insurance TPA Pvt Ltd Pawan Bhalla 0129-2564057 pawan[@]rakshatpa[dot]com
8 Family Health Plan Insurance TPA Limited G.Bharathamma 040-23556464 bharatig[@]fhpl[dot]net
9 Vidal Health Insurance TPA Private Limited Sudha Sahar 080-40125678 sudha[@]vidalhealth[dot]com
10 Health Insurance TPA of India limited SK Mehra 020-4765800 sk.mehra[@]hitpa[dot]co[dot]in

Role of TPA in the Insurance Sector

TPA plays a vital role for both insurance companies and policyholders.

Their role is varied as mentioned below.

  1. Acts as a mediator between Insurers; policyholders & hospitals.
  2. Claims Processors.
  3. Claim Settlement.
  4. Cashless Approvals
  5. Inpatient treatment from hospitalization to discharge.
  6. Stakeholder’s management.

How to Manage Claim Settlements through TPA (Third Party Administrators)

TPA helps in the faster settlement of claims by acting as mediators. In case any of our claims are rejected due to some reason then we can either catch hold of Insurance companies or TPA’s. Details of third party administrators are freely available on the company's website. One Insurance company can have many TPA's as well based on the network hospital for cashless treatments.

The first step in availing any health policy is to check their list of network hospitals for cashless treatment. We can easily check the same from the website of an insurance firm as shown below.

Never Pay Any Additional Cost to TPA

This is everywhere an important aspect of insurance that we should be well versed in. At time’s lots of misselling happens by agents in order to mint some money by charging additional for TPA service.

However as per the rule of IRDA; TPA’s are sole discretion of insurance providers within the cost of the premier of the policy. At times they may have an in-house team or they may choose to outsource it without any additional payment from our side.

TPA is facilitators who assist in the process of speeding up the process of a claims settlement.

In fact, they are additional benefits for the policyholders and offers the following benefits.

  • Database Management
  • Speedy Claim Settlement
  • Offers additional Wellness Programmes
  • Assists in settlement of Claims
  • Manages any claims rejections

Why do Insurance Companies Need TPA’s?

We may wonder that within the same cost paid by us how to do some insurance companies able to provide us the benefits of TPA’s.

This is due to the following reasons.

  • To make the process faster
  • Have a dedicated institute to facilitate claims settlement.
  • Make the process organized and smooth.
  • Coordinating the complete process from patience admission; treatment; discharge to claim settlement.

The above details not only help Insurance firms maintaining their branding but prove cost savvy as well for them.

How Does TPA Works?

Usually, these third party administrators referred to as TPA are experts in managing the documentation and making the claim settlement convenient. This can be very well explained through a short case study.

Step 1 - Cashless Treatment

Ramesh works in Genpact. His wife is diagnosed with a Kidney stone; doctors suggested to get it operated. He has taken a health insurance policy from Apollo Munich Health Insurance Company.

He plans to go for cashless treatment. The first thing he’s going to do is check the list of network hospitals.

Once he selects a suitable hospital. The next step is to visit it and get in touch with the insurance department; the rest is taken care of by them. TPA’s plays a significant role here by a faster settlement of claims. They are often well connected with the insurance department of a hospital. Our role is limited to sharing our policy numbers with the Insurance department of hospitals. At max, we can contact our Insurers and rest is taken care of by Third-party Administrators.

Step 2 - Non-Cash Treatments

At times we may not be able to take treatment from the empanelled hospital due to any personal reason. In that case the process remains the same . Only difference is we need to pay ourself initially and settle the claims later through our insurers. Usually, if all our documents are in place than claim settlement should not take more than 30-45 days. TPA plays a vital role in processing it as well.

Why there’s Need of TPA and How the Organisations Get Benefitted?

TPA’s are separate entities as they need to perform a couple of tasks and further adds lots of benefits as elaborated below.

  • Managing Documentation
  • Coordinating the complete process from patience admission; treatment; discharge to claim settlement.
  • Information Management
  • Specialized services by Information Management

Limitation of Using TPA

  • Since TPA are not the actual policy providers they may not have adequate information.
  • Customers often get confused between agents & TPA’s
  • At the time of emergency, a policyholder may not trust TPA completely for claim settlement during rejections.
  • If any documents of policyholders are pending then TPA may not be able to help much.
  • If an insurance provider doesn’t provide appropriate information of policyholders than there may be a delay in settlement of claims.

How Can We Overcome Limitations and Avail Complete Benefits of Our Policy?

  • It’s prudential to keep all the details handy especially contact details of insurance agents.
  • We must check the empanelled list of hospitals providing cashless facilities and concerned TPA to manage rejections.

Health Insurance policy is also synonym to our prestige and dignity as it saves us from extending hands in front of anyone. So we should buy a policy that suits our health conditions and budget.

Alternatively, we can compare different health policies and choose the best one as well. Policy X is proactively engaged in providing the best plans out of many.

You may check the quotes before deciding on the website.

Naval Goel is the founder of PolicyX.com. He is an Associate Member of the Indian Institute of Insurance`, Pune. He has been authorized by IRDA to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.
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