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The Third Party Administrator (TPA) acts as an intermediary between the insurance company and the person taking the insurance.

Health insurance has become a necessity in today’s era. Those who were not even thinking about medical insurance till two years ago are now getting health insurance after the outbreak of the Covid-19 pandemic. The insurance ensures that the family can get the right treatment and financial security in difficult times.  If you are thinking of buying health insurance, then keep in mind that the network hospital of the company from which you are taking a health insurance policy is suitable for you.

One should always go for the plan which offers maximum network hospitals in the area to be safe in times of emergency. Network hospitals are a group of hospitals that allows you to redeem your current health plan. If the hospital network of an insurance company is not good, that is it does not include good hospitals, then you may not get the right treatment in case of emergency.

Cashless claim

Cashless claim in health insurance is a claim settlement method where the policyholder does not have to pay cash for the treatment and the bills are settled directly between the hospital and the insurance company.

For this, the health insurance plan provider has to be intimated two days in advance in case of hospitalization by making a plan and within 24 hours in case of emergency hospitalization. The bills are settled under the TPA and the mediclaim card has to be submitted to the hospital.

In case of cashless settlement, keep in mind that the treatment should be done in the network hospital of the insurer, if this is not possible, then provide the bill to the insurance provider for the reimbursement of the bill amount.

Third-party administrator

The Third Party Administrator (TPA) acts as an intermediary between the insurance company and the person taking the insurance. Its main function is to assist in the claim and settlement process. TPA issues the card to the person taking the insurance. Only by showing this, treatment can be done in a hospital with the help of a cashless facility

At the time of a claim, the person insured gives prior notice to the third party administrator. After this, he’she is asked to go to the concerned hospital. This is the network hospital of the insurance company. The customer can also go to another hospital for treatment, the cost of which can be met through reimbursement.

The third party administrator issues a letter to that hospital, after which all the bills are sent to the TPA for payment after monitoring the case and charging the hospital.

TPA sends all the relevant documents along with the bill to the insurance company for payment of the claim.