TPA helps medical insurers in making their claim settlements. The full form of TPA is Third Party Administrator which means they act as a middle man between the insurance company and the insurers. Whenever a party gets admitted to the hospital, he can contact TPA to get the claims.
Insurance companies also have their in-house claim settlement department but TPAs are much more efficient. Companies have to handle a lot of work- be it approving or rejecting claims, handling customers, etc. This often leads to an overwhelming workload and thus claim settlement may get delayed. A TPA in health insurance helps the company by looking after this area and since they are not burdened with other work, they can dedicate all their time and workforce to a particular activity.
Choosing the right medical insurance company and the right TPA is very important. This will ensure that you get decent coverage and can receive treatment from the best hospitals all around the world. People are slowly gravitating towards large network TPA in health insurance due to some solid reasons. We will explore those reasons in the course of our article. But before that, let us clearly understand what TPAs do.
The Role of TPAs
Most health insurers do not like to deal with accepting intimation, claims, and settlement and thus they outsource such kind of work to TPAs. TPAs issue health cards that can be used during hospitalization and filing for claims. Thus, in case you need to be hospitalized, it is not the company you should contact but the TPA who has a tie-up with your insurance company. Your hospital will get a heads up from them and you can simply show your card to get admitted. And at the time of discharge, all your bills and other important documents will be forwarded to the TPA, who then will forward it to the insurer for your claim to be processed.
Can I Choose My TPA?
TPA in health insurance is generally chosen by the insurance company. They are to decide which third-party administrator would they want to carry on their claims settlement affair. However, according to the guidelines of the Insurance Regulatory and Development Authority of India, insurers will have to offer the policyholders the option of choosing their TPA. But the insurers will have to choose from among the TPAs that are engaged by the insurer.
One must remember that once you have chosen your medical insurer, you will not have much discretion in selecting your TPA. Thus the best way is to find out which one is the best TPA in health insurance and look for insurers who have a tie-up with them. This way you get to choose the services of a particular TPA.
Reasons to Choose Large Network TPA
While you are choosing a good TPA, make sure that you have done your research well and found one that offers you an extensive network of hospitals and medical services. There are several advantages of having such a TPA.
A TPA with a large hospital network can help you get the best treatment.
You Can Choose Your Hospital
TPA in health insurance companies has a tie-up with hospitals. And the larger network they have, the better are your chances of getting treatment from a hospital you wish to choose. If you know a certain hospital has the best doctors or the best in a particular field, a TPA with an extensive network will have better chances of placing you there than one with a small network.
Get Hospitalised Across the Country
A TPA that has a widespread network of hospitals also establishes its connections with hospitals all around the country. They get people from different cities and towns. In order to serve them equally well, they extend their network. This works great for people who have switched cities as you need not change your insurer or face too much of a challenge when you need medical attention in a different city.
Having a TPA in health insurance policy that offers you a network of the best hospitals can be extremely beneficial. It makes the best treatment possible as you can choose a specialized hospital anywhere in the country. It does not dim down your options or make you settle for less. They make sure that you get the value of your insurance.
The best TPA in health insurance makes sure that you get a quick settlement and do not have to get harassed. The larger the network, the better reputation a TPA has. Which means they can quickly settle your claims and move on to the other patients. Since they have connections with so many hospitals, they would not like to have a bad name as that can be extremely bad for the business.
The right TPA can come with several advantages, especially the one that has an extensive network. It lets you access different hospitals and does not restrict you with limited options.