Health insurance claims settlement

most of the insurance companies depend upon Third Party Administrator (TPA) for carrying out the procedure of the claims. The simple meaning is, one the insurance policy is sold to the policy holder, and the insurer passes on the responsibility to the TPA. This way, all the verifications and formalities are completed through the Third Part Administrator (TPA).

Over the time, health insurance has proved to be one of the most asked policies. Often customers wonder about the settlement of the claims, and the process whereby the claims are settled by the insurance companies. This article will thereby give you a bit on how health insurance claims processing works.

These days, most of the insurance companies depend upon Third Party Administrator (TPA) for carrying out the procedure of the claims. The simple meaning is, one the insurance policy is sold to the policy holder, and the insurer passes on the responsibility to the TPA. This way, all the verifications and formalities are completed through the Third Part Administrator (TPA).

The insurance companies have brought two basic ways to settle the claim, such as;

Cashless option- In the cashless way, the treatment can be undertaken only at some of the specified network of hospitals. The things required to be done in this type of settlement in detailed information to e given to the TPA, and he should be informed well in advance about the treatment and the period of hospitalization planned for the insured. The amount that is claimed should be claimed by the TPA. In case of any type of exclusions the TPA settle the amount with the hospital and informs the insured.

Reimbursement option– The reimbursement option can be availed at any hospital chosen by the insured. Here, the insured takes up the treatment at the hospital and settles the bill directly. After that, he can claim the reimbursement of the money spent during the tenure of the treatment by submitting all the necessary bills and documents to the TPA. After the approval of the TPA, the insured is paid the reimbursement by the insurance company.

Here, it’s observed that the Third Party Administrator (TPA) is given utmost importance for getting the claims settled. The TPA is given incentives to settle the claims and they are not linked directly to the insurance policy. So, many times, they take a lot of time to make the settlements of the claim. So, it’s best to check with the TPA of the respective policy, and would be helpful enough to process the claims in the near future. There are even insurance companies who settle the claims directly without any help from the TPA.

These are some of the common steps to settle your claims and get the money for the treatments done; it’s easier to go with the procedure if you are aware of the basic details beforehand.