When browsing through the family health insurance category, you must have come across the term ‘third party administrator’. Also called TPA, the third party administrator is a type of intermediary body that helps the policyholder in several ways. The third party administrator is unique to health insurance and cannot be found in any other type of general insurance category. Unknown to many policyholders, the TPA handles many responsibilities that make insurance an easier experience. In this article, we take a look at the role and importance of the TPA in family health insurance.
- Acts as a link between the insurer and the insured
The third party administrator is a vital link between the policyholder and the insurance company. When you buy a Mediclaim policy for your family, you are given an authorized health card. This card includes your policy number and the TPA you need to contact when a claim has to be raised. It is the TPA who mainly issues this card and it is the TPA who will be a major instrument in settling your claims.
- Helps immensely during cashless claims settlement
As you may be aware, a cashless claim is settled by the insurer themselves instead of being paid by the policyholder. However, many may not know that it is primarily the TPA who manages the cashless claims. They are the ones who deal with the hospital regarding the treatment bills and settle them orderly.
- Evaluates hospitals to add to the empaneled list
Network hospitals, where one can access cashless services, are chosen by the third party administrator after careful evaluation. There are many parameters that the TPA uses to assess the hospitals such as the medical infrastructure, administrative ease, qualified staff, and so on. This helps policyholders and their loved ones have the best health insurance experience, especially when it comes to getting high-quality cashless treatment.
- Maintains a record of policyholders
The TPA body keeps an account of the several policyholders that are insured with a particular insurer. Vital records relating to the claims made by each policyholder are also maintained alongside.
- Provides additional services
If you have any queries or doubts about your family health insurance policy, you can reach out to your third party administrator. They often provide these services for the ease of their policyholders. In many cases, you can even avail of a 24/7 assistance service. One can track the status of their claims, seek assistance, and access details regarding how to raise a claim through the TPA helplines. You can also ask the TPA about the nearest network hospital when you are seeking medical treatment.
- Verifies claims and deals with rejected claims as well
The TPA body is equipped with a qualified group of doctors, legal persons, consultants and so on that collectively verify claims based on the documents and evidence provided by the insured under the Mediclaim policy. If the claim is found fake by the TPA, it can be rejected by the insurer. They also deal with rejected or disqualified claims to a certain extent.
Some TPA bodies are also responsible for managing health and well-being programs for the policyholders of family health insurance. Thus, the TPA performs a variety of roles that greatly establish their importance within the health insurance sector.