What is TPA in Health Insurance and Services Offered by TPA

Here, you may know what is TPA in Health Insurance and the role played and allowed to TPA in the insurance sector, also find the advantages of TPA to customers…

In the Health Insurance sector, TPA stands for Third Party Administrators basically known as third party insurance services which are allowed by the Government of India to ease the process of claim settlement without any delay to provide the finance for medical treatment. So, that the general public can avail the health insurance policy services like claim settlements related to health through these lists of TPAs allotted.

Health Insurance has become a necessity during these times because if you face any medical emergency or have to aid yourself during these times in terms of finance then it would be hard and breathless if you do not have Health Insurance with you.

Difference between TPA and Insurance Company

General Insurance company is an authority who issues the medical insurance policy to the customer as per the laws, whereas the TPA (licence entity) is appointed by the insurance company who acts as a middle level authority between customer and insurer in processing the claims bills pursuing the documents, whereas the final authority to sanction the claim is Insurance company only.

One of the major reasons why the establishment of different Third Party Administrators (TPA) has been effective is to provide everyone with a chance to face their medical necessities without the worry of the financial crisis that is ahead of them.

Over the past few decades, the TPA systems have been developed and have taken into consideration different health illnesses and diseases that can help cover most of the medical emergencies.

This is an effort towards providing by every Health insurance company with an aim to help their insurance policyholder in any situation to face any medical diagnosis through their life, and some of the benefits of TPAs in Health Insurance are

Advantages of TPA in Health Insurance

  • Health Policy cards will be issued for an individual or families as well.
  • 24 / 7 customer care services related to mediclaim.
  • Issues Health Insurance ID Cards and Numbers to policyholders.
  • Pre hospitalization and post-hospitalization medical billing to be verified in a fast manner and approved
  • E-Card facility for regular medical assistance with some
  • Fast Insurance money claim process through online and offline with trained and focussed management
  • Ensures better claim services from TPA on behalf of Insurer
  • Provides track the claim through online, SMS, or through TPA apps
  • But it is necessary to understand that all the claim and Insurance related aspects are only proceeding if applicable and eligible under the Mediclaim law. If not, then the Insurance TPA is not allowed to authorize the claim.

Frequently Asked Questions

Is TPA a Government Insurance body?

  • No, TPA stands for Third Party Administrator which is basically governance or company which provides Insurance and claim under the respective Insurance policy.
  • Though each of the company or the organization which is dealing with the health insurance has to follow and abide by all the laws represented by the Mediclaim laws.

Does an Insurance company be a TPA in any scenario?

  • Yes, according to the latest Mediclaim law all the Third Party Administrators are also the Insurance companies that have to follow the Mediclaim laws for allowing insurance claims for policies.
  • So, in this aspect, any Insurance company can be called a TPA, and though people confuse TPA to be a government entity and if TPA is any Insurance company that has to follow the Mediclaim laws.

Which is the best TPA in Health Insurance?

  • There are dozens of TPA companies out there in the Health Insurance which are chosen by thousands of policyholders over time, and it is to be understood that no TPA is made in such a way that it suits every medical necessity.
  • Keeping that in mind, the customer is not having any link with TPA directly in policy servicing, and the TPA will be appointed by Insurer to check all the billing claims and the process you will be accounted for, and only.