Being sick or facing a sudden medical emergency is very stressful for anyone. On top of that, if one has to worry about the hospital bill and expenses, then the trouble of the patient and his family increases further.
In such a situation, health insurance acts as a protective shield for us. But the problem arises when one does not understand how to use it in the hospital, that too when the facility of cashless treatment is required.
Here the role of TPA i.e. Third-Party Administrator becomes very important. Now the question arises – what is TPA? And how does it help you in the hospital?
What is TPA?
The full form of TPA is Third-Party Administrator. It is an authorized organization that acts as a bridge between your health insurance company and the hospital.
When you are hospitalised and want to use your insurance for treatment, the TPA checks your policy, processes the documents and helps you get the treatment approved. This saves you from having to pay for the treatment yourself initially, provided the treatment is covered by your policy.
What is the difference between a TPA and an insurance company?
People often confuse a TPA with an insurance company, but they have different roles.
| Aspects | Insurance company | TPA |
|---|---|---|
| Who is it? | The original entity that provides your health insurance policy | A service provider appointed by the insurance company |
| What is the job? | Paying your medical costs | Processing, approving, and coordinating documents |
| Who makes the decision? | The final decision on claim approval is made by the insurance company | The TPA prepares the claim and sends it to the insurance company |
In simple terms: The insurance company makes the payment and the TPA facilitates the whole process.
Why is TPA important during hospitalisation?
Suppose someone suddenly gets chest pain and is rushed to the hospital. At such times, the family is primarily concerned about treatment, not filling forms or getting the policy checked. This is when TPA comes in handy.
Real-life examples:
- In case of emergency: TPA instantly confirms the policy so that there is no delay in treatment.
- In planned treatment: In cases like surgery, cashless facility can be ensured by taking permission from TPA in advance.
With the help of TPA:
- Treatment is not delayed
- It is easy to understand the terms of the policy
- The hassle of forms and paperwork is reduced
- There are no financial surprises
What if the hospital does not have a TPA desk?
Imagine, when a loved one is in ICU and the family has to do things like collecting policy forms, doctor’s reports, photocopies of identity card and sending emails to the hospital – how difficult it would be!
That is why every good hospital should have a TPA desk, where professionals handle every process related to your insurance.
Our in-house TPA desk at Heritage Hospitals is available every day to ensure that your treatment is not interrupted.
How does the TPA process work at Heritage Hospitals?
Heritage Hospitals has made this process extremely simple so that patients and their families do not have to deal with paperwork along with treatment.
Step-by-Step Process:
- Admission:
The patient or family member visits our TPA desk with the TPA card and ID. Our team helps in filling the pre-authorization form. - Approval:
The documents are sent to the TPA who checks the policy and sends it to the insurance company. - Treatment:
The treatment begins once the approval is received. The billing team stays in touch throughout the process. - Discharge:
The final bill is sent to the TPA, and after approval the patient is discharged.
If some expenses are not covered under the insurance, the same is informed.
TPAs and Insurance Companies associated with Heritage Hospitals
Heritage Hospitals has a very wide network. Whether you are under a government scheme, a corporate policy or have personal insurance – our TPA desk will help you.
TPAs:
- Medi Assist
- MD India
- MedSave
- Health India
- Raksha TPA
Insurance Companies:
- HDFC Ergo
- ICICI Lombard
- Aditya Birla
- Star Health
- Niva Bupa
Government Schemes:
- Ayushman Bharat (AB-PMJAY)
- CGHS, ECHS
- Railways, NTPC, IIT BHU etc.
If your company or TPA is not in the list?
No problem! Our TPA desk will still help you – be it the reimbursement process or document preparation.
Why patients trust Heritage Hospitals?
Heritage Hospitals is at the forefront not just in treatment but also in simplifying the insurance process. We have:
- 50+ TPAs and insurance partners
- Clear and honest billing
- High claim approval rate
- Personalized assistance
We provide a dedicated staff to every patient, who helps at every step from admission to discharge.
Some frequently asked questions (FAQs):
- Can I use my health insurance at Heritage Hospitals?
Yes, most policies are covered under our network. If not, our team will help with reimbursement. - What is a TPA?
TPA is an intermediary that coordinates between the hospital, insurance company and the patient to ensure cashless treatment. - How does TPA work in a hospital?
On admission, the insurance details are sent to the TPA by filling up a form. Treatment begins after approval is done and the documents are done till the time of discharge. - Do corporate employees also get cashless treatment?
Sure, our team provides specialized support for corporate clients. - What documents are required?
- Insurance card
- Valid photo ID
- Doctor’s advice (if any)
Conclusion
The most important thing during treatment is peace of mind. If you are sick, your entire focus should be on treatment and quick recovery, not on getting the claim approved from the insurance company.
At Heritage Hospitals, we aim to give you an experience where there is treatment, but no stress. Our TPA services work on this very philosophy – so that you can focus on recovery and we take care of the rest.
