Benefits Of TPA To Policyholders

An essential benefit is that the policyholder gets an opportunity to get treated at any of the hospitals in the TPA’s empanelled network and make use of the services as per need and choice. Moreover, for every recurring hospitalisation, the policyholder will have the advantage of knowing whether the treatment he or she wishes to undergo is covered under the health insurance policy bought. Similarly, during emergency hospitalisation, all the policyholder or the dependant has to do is to show the health insurance card and get admitted at any of the network hospitals for treatment. No amount would be charged from the policyholder or any of the insured under the policy at the time of discharge from the hospital. Some TPAs provide added services like an ambulance referral or advising about any surgeon or specialist who can help.

Statistics highlight how a lot of Indians continue to be ignorant. Since most of the customers are unable to understand the technical terms and jargons included in the insurance proposal, they face the risk of claim rejection. TPAs enable an efficient delivery network that ensures that the policyholders do not feel cheated and are the ultimate beneficiaries of the insurance they had paid for.

Before the TPAs came into the picture, lots of policyholders complained about how they found it difficult to get their medical expenses reimbursed from the concerned insurance company. However, as now reimbursements are routed through the TPAs, it is the TPAs who meet the hospital expenses by paying the healthcare provider from their fund and then get reimbursed from the concerned insurance company.