Health Insurance 880 views June 14, 2021

TPA vs In-House Claim Settlement

While buying health insurance, you may come across terms such as Third Party Administrator (TPA) and In-house claim settlement. Both these are claim settlement intermediaries by which you can get your health insurance claim settled by the insurer. A TPA is an Insurance Regulatory and Development Authority of India (IRDAI)-approved health care service provider that provides access to network hospitals, cashless hospitalization as well as timely claim settlement. Whereas in-house claim processing department is set up by insurers within their own company. In this post, you’ll learn about the differences between TPA & In-House Claim Settlement. So read on!

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Compare TPA & In-House Claim Settlement Services

Health insurance claims can be made cashless or through reimbursement. To help you with that, the insurer provides you the following intermediaries. Let’s compare the TPA and in-house claim settlement services and find out which one is better.

Which One Provides Faster Claim Settlement – TPA vs  In-House Claim Settlement?

TPAs build a liaison between the customer and the insurance company regarding the claim settlement. Whereas, in the in-house claim settlement process, there is no TPA, instead, the insurers set up an entire department within their own company to act as in-house claims processing department known as the Health Administration team (HAT). The in-house claims processing department’s turnaround time (TAT) for resolving a query or claim is faster compared to a TPA due to less time taken to decide about claim processing due to direct contact between the customer and insurer in case of the former.

Which One is More Flexible – TPA vs  In-House Claim Settlement?

TPAs may come in handy in several situations like cashless facilities in case of planned and unplanned hospitalization, etc. And you can find the TPA counter at the network hospital and get a speedy pre-approval for the cashless claim.

In case your cashless claim is rejected, you can file for reimbursement by submitting the duly filled claim form along with the original bills and prescriptions to the TPA. The TPAs’ primary job is to help you get your claims settled. TPAs act as a direct point of contact for the customers, and they don’t have any role in claim approval or rejection.

Which One Has a Wide Range of Network Hospitals?

TPAs have access to a wide range of network hospitals compared to an in-house claim settlement. The insurer provides you the option to choose your TPA at the time of policy purchase. TPAs issue health ID cards by which you can get cashless medical treatment at the network hospital.

Which One Helps in Resolving Claim Settlement Queries?

If there is a discrepancy regarding the claim, the In-House Claims Processing Department resolves the same. Whereas no such benefit applies when filing a claim with the TPA.

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