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There are several reason why TPA should important and unavoidable factor in health nsurance

Claim Settlement: TPAs are the ones concerned with dealing with Claims- complete from taking intimations of claims, advising customers on network hospitals, approving cashless and reimbursement claims, to finally disbursing the claims to the customer.

Cashless Service: Cashless Service is one of the important functions of the TPAs today which means that if you are hospitalized in a hospital among the ones listed by the insurance company, the bill is paid directly by the Insurance Company and you don’t have to shell out anything. But, policyholders find it difficult to avail the cashless Service in a network hospital because there is very less awareness regarding TPAs. Policyholders mostly rely on their insurance agents who don’t inform them about it.

Maintaining Database: Once the policy has been issued, all the records are passed on to the TPAs and all further communication of the Policyholders is with the TPAs and not with the insurance companies. It is the responsibility of the Third Party Administrator to maintain databases of policyholders and issue them identity cards with unique identification numbers. Policyholders have to make sure that they receive the identity cards from the TPA within 30 days and have it ready in case of any emergency.

It is essential that you know your TPA name and contact number since it is the TPA that the Policyholders are supposed to contact in the case of hospitalization or claim settlement.

Toll Free number: TPAs have to run a 24-hour toll-free number, which can be accessed from anywhere in the country. They have full-time medical practitioners under their employment who will immediately take a decision on whether the ailment is covered under the policy.

Value Added Services: TPAs also perform some of the additional value-added services to the consumers, like arranging ambulance services, medicines and supplies, guiding policy holders for specialized consultation, and providing information about 24- hour help lines, health facilities, bed availability, organization of lifestyle management and well- being programs.

With the advent of TPA, the insurance companies aim at ensuring higher efficiency, standardization of charges, greater awareness and penetration of health insurance to a larger section of the people. There also a trend among the insurance Companies today to terminate the contracts of TPAs and having in- house TPA due to the rising claims and losses.

Whatever may be the case, knowing about your TPA will surely smoothen the process of claim settlement and insurance service.

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Importance of TPA in health insurance

Tags: Policyholders, reimbursement claims, value-added services