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Health Insurance

Benefits Of TPA To The Insurance Companies

The TPAs, since they were first introduced, have gone a long way in curtailing the costs of the insurance companies. This is because the insurance companies did not have to spend on increasing or spreading their network throughout the country, especially to the remote areas. TPAs act as the most vital link between the three elements of the health insurance sector including the policyholders, the health service providers and the insurance companies. As treatment facilities scramble to make more money to run their operations and earn profits, insurance companies look at all means to control their costs. As an increasing number of people prefer to opt for the cashless option, it is the role of the TPAs to identify the actual expenses that may have been incurred and the credibility of the amount to be paid by the insurance company. 

 

How Do the TPAs Function?

The TPAs function as the intermediary between the insurance company and the policyholders by facilitating the claim and settlement processes. To customers opting for cashless hospitalisation services, the TPAs issue the ID Cards to the policyholders. These policyholders can show these cards while gaining admission to the hospital for treatment during an emergency. Also, the TPAs assist the policyholders by giving them details about the nearest hospital in the insurer’s network so that they may avail the benefits of cashless settlement. However, if the customer opts for some other hospital outside the insurer’s network, then the TPA enables reimbursement of the claim payment. For easy and quick claim settlements, the TPA collects all the necessary documents including bills and the copy of the claim to the insurance company.

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