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As a health insurance policyholder, you must feel a certain relief to know that your future is secure and you are
financially protected in case any health issues occur. But on the other hand, there’s also a certain degree of
concern with respect to the claim processing and settlement. At the time of filing a claim, you should use all
the help you can get to ease the filing process. Fortunately, you have third-party administrators (TPA)
assisting you throughout the claim filing process.
Every insurance company appoints a third-party administrator that acts as a middleman between the insurer and the
policyholder. There are many aspects involved in filing a claim. You have to be accurate with your details and
documents and follow due process. If you leave anything out, your claim may be rejected or will take longer to
process and accept.
There are chances that at the time of filing a claim, you may face difficulties or find yourself in a state of
confusion. This is where TPA plays an important role. They help you with every single detail that you need. They
are the experts who aim to provide you with a seamless claim process.
The claim settlement process can be quite a handful. But it’s the third-party administrator's responsibility to
educate you about the same and provide end-to-end assistance throughout the process.
A TPA is appointed by insurance companies to help you file your claim. The TPA acts as a link between you and
your insurer. In case of any inquiries from you, they are your representatives who get those queries resolved by
connecting with the insurer. To file a claim, you should inform your insurer as well as your TPA so you can
utilize their services right from the beginning.
Third-party administrators are highly efficient in conducting the entire claim settlement process. To put it
simply, they know how things work in the insurance industry. With TPA by your side, you get access to many
services. You can let your third-party administrator lead the process and expect complete accuracy throughout.
Since you informed your third-party insurer about your claim right at the beginning, you get to enjoy all the
assistance offered by them throughout the process. A TPA helps you out in the following aspects of the claim
Access to the cashless hospital network
Inquire with the hospital
The ID number for claim settlement
and more. Before buying your
health insurance, you can check with your insurance company regarding the services offered by the
third-party administrator that they have a tie-up with.
Third-party administrators are highly reliable as they are authorised by the Insurance Regulatory Development
Authority of India (IRDAI). Hence, they work along the laws and regulations to provide you with the right
assistance in your claim settlement process.
Yes! No matter if you opt for reimbursement or cashless claim settlement, you can utilize the services of a
third-party administrator in either of those cases. Cashless claim settlement in itself is very helpful, and
with the assistance of a third-party administrator, your entire process, including consulting with the
hospitals, helping you with the hospital car, connecting with the insurers, etc., is taken care of.
The third-party administrator is only available to public-sector health insurance companies. If you have your
policy with any private insurance company, you can rely on their in-house claim processing department.
TPA is only responsible for helping you in the process of claim settlement. They depend on the insurance company
for the final settlement. Hence, they are not responsible for the acceptance or rejection of your claim.
TPA does not charge you directly. The insurance companies pay them a certain percentage of the claim amount.
If you want to eliminate or change your TPA, you will have to inform your insurer and offer a valid reason for
Third-party administrators are available only in health insurance and not in any other kind, like life insurance
or motor insurance.
Claim processing in health insurance can be arduous
for some, as health adversities bring time turmoil and inconvenience. The last thing you want is to go through a
complicated claim settlement process. Hence, a third-party administrator can be of huge assistance and be the
pillar of support that you need.
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