5 min read
When you need to file a claim request as part of your health insurance policy, you can do it either directly with the insurer or with TPA. What exactly is TPA and is it different from the insurer’s claim department? Let’s understand all about this in this post.
Before we proceed, let’s begin by clarifying what exactly does TPA stand for so that it isn’t confused with the insurer. TPA refers to a Third-Party Administrator and, as you may have understood by now, health insurance TPA is indeed different from your insurance company.
Your insurer may outsource claim-handling to a third-party group to process all claims from the policyholders on the behalf of the health insurance company. This third-party group is known as TPA in health insurance. Interestingly, both the insurer and TPA insurance work quite differently when it comes to handling claim requests from the insured.
Let’s begin by understanding what TPA is its role in health insurance. The TPA desk is essentially an outsourced support team that handles all medical claims filed at a hospital. Your insurance company appoints this support team for its assistance to mediate between the hospital authorities and the insured for a smooth claim-settlement process for both.
Serving as a mediator, the third party administrator insurance also handles all communication and correspondence that takes place between the insurance provider and the policyholder with regard to claims. It must be remembered here though that TPA is merely a mediator and has no authority to either accept or reject a health insurance claim filed by the insured.
It only works on making the whole process simpler for both the insured and the hospital staff on behalf of the insurer. The final authority to accept and reject claims and also settle the amount for each rests solely with the insurer.
Having understood what exactly is a TPA team, let’s now look into its actual role and how it functions when it comes to claim-settlement in medical insurance. The TPA desk has the following 3 primary roles to perform:
Note: The Insurance Regulatory Authority of India (IRDAI) has provided authorization to nearly 26 Third-Party Administration companies in India. Each TPA has a unique code which the insured must enter while filing a claim request with the insurer.
Now let’s move on to another party involved in the health insurance claim-settlement process for the insured. The in-house claim-settlement team is your insurance company’s own team handling all the claims for the insurer within the company itself. It is therefore different from the outsourced TPA desk detailed above.
Each insurance company has a dedicated department within to handle all medical claims filed by the insured. Unlike TPA, this team directly coordinates with the insured to handle all claim requests.
The primary responsibilities of the in-house claim-settlement team include:
We discussed in detail above about the meaning of TPA and the in-house claims department of the insurance company. We also discussed each of their roles and functioning with regard to the claim-settlement process for the insured. Now, a common query that most policyholders have is which one should they really go to or approach when it comes to filing a claim request. Which team is more friendly to the end customer?
If you look at it closely, the services provided by an in-house claims-settlement team clearly outweigh the benefits of a third party administrator in health insurance. The following proves this point:
As can be understood from the post, the in-house claim settlement department is generally better at handling and resolving claim requests directly with the insured party. Hence, this proves that it is hands down more efficient and customer-friendly versus the TPA desk.
You deserve the best of health insurance!
Answer a few simple questions to determine the ideal plan that suits you best at PayBima Health Advisory.
View this post on Instagram
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.
Universal Health Coverage Day is observed every year on December 12 to make sure that people around the world can have access to high-quality health services.
The quality of air continues to deteriorate in India, especially in the northern region with the air quality index (AQI) in the critical category. This.
A vibrant land of cultural coalesce, India amuses the world with its unique values and diversity. The festivals play a significant role in this regard..
Insurance is an indispensable requirement. However, not everyone can afford individual medical insurance to stay covered against major uncertainties, especially after retirement. If that is.
Cancer is a disease that needs no introduction. We all know how deadly the disease is and how rapidly it is spreading across the world,.
Like in other products, GST is levied on health insurance policies too. But did you know that an NRI or non-resident Indian with a health.
Antibiotics are like marvels of medical sciences which have transformed the healthcare sector by limiting some of the deadly infections. From the earliest discovery of.
Speak to our advisor
Mahindra Insurance Brokers Limited (A Mahindra Group Company) - Unit-202, A-Wing, 2nd Floor, Amiti Building, Agastya Corporate Park, Kamani Junction, LBS Marg, Kurla West, Mumbai - 400070. Tel: +91 22 66423800
Licenced by IRDAI License No. 261; License Validity : 17-05-2025; Category : Composite Broker; CIN : U65990MH1987PLCO42609 Member of Insurance Brokers Association of India (IBAI).
Insurance is the subject matter of solicitation.
For a seamless experience, use the latest version of Chrome/Firefox/Internet Explorer.
Copyright © 2023 Mahindra Insurance Brokers. All Right Reserved.
Verify your number to activate your best premium offer
Please enter the OTP sent to XXXXXX 4099 to continue