It’s not always you plan to have a medical procedure. Sometimes, it just happens out of the blue. If you have ever been hospitalized, you will know that it is not an easy process. There are so many forms and procedures, it can be confusing. One such procedure is the hospital TPA desk. This is an essential thing you need to know, if you want to claim insurance.
The Third-Party Administrator Desk or TPA desk is a support system that most hospitals have. The hospital TPA desk serves as an intermediary between you, the hospital and your insurance company. There’s a lot you need to know about the hospital TPA desk, which is why we have written this blog. We hope to give you a quick overview, so you know what to expect next time you visit the hospital.
Hopefully, after reading this blog you won’t be confused anymore! Do give it a read, and share it with your friends and family. They could benefit from this guide as well.
What is a Hospital TPA Desk?
As we mentioned above, the hospital TPA desk is the ‘desk’ or service that connects your insurer to you and the hospital. All TPA desks needs to be licensed by India’s Insurance Regulatory and Development Authority (IRDAI). That allows them to function as a support system for claim settlements. Think of them as your insurer’s representative at the hospital.
The role of the hospital TPA desk is to verify that your medical health policy covers the procedure you or your family member are about to undergo. They will be able to approve the claim, if it is covered by your medical health insurance policy.
Here are some of the things the hospital TPA desk does-
- Provide a no-cost service to verify your health insurance policy and claims request
- Guide you on what will be applicable for claims, and what you will have to pay as out-of-pocket costs
- Act as a knowledge resource for all details on health insurance protocols, claims, exclusions and inclusions
You can find the hospital TPA desk in almost all hospitals. Of course, not all hospitals will have TPA desks for all insurance companies. If your insurer has a hospital as part of their network, it is very likely you can find a TPA desk at that hospital. For non-network hospitals, you might find a TPA desk. If not, you will have to call up your insurer and send them the documents to verify your claim.
Protocols of the TPA Desk
If the hospital you are at has a TPA desk, you can easily access three different services:
- Claims Settlement: the primary role of the hospital TPA desk is to verify your medical insurance coverage and help with claims. If cashless claims are applicable, they work with the hospital directly to facilitate quick payments for the treatment.
- 24×7 Helpline: the hospital TPA desk is also a 24×7 helpline, helping you at any time you need. They can answer all your questions, verify your policy and update you on your claims process.
- Value Added Services: today, many TPA desks also provide value added services such ambulance services, lifestyle management guidance, and wellbeing programs. Any and all services provided by the desk are free of cost.
Here’s how the system works. In the unfortunate instance you or a family member is hospitalized, you will have 24 hours to get in touch with the TPA desk. Simply approach the desk with your health ID card, government ID and any documents the hospital has provided. The desk will then verify your medical cover, and tell you how to proceed.
In case of cashless treatments, the desk will collect the bills directly from the hospital and approve the claim. In case cashless is not available, you will have to collect the bills after paying them, and hand them over to the TPA desk. They will then verify your insurance and reimburse you for the costs.
TPA desks are important because they help in improving the efficiency of insurance services. They also help improve knowledge of healthcare, minimize costs and help avoid unnecessary delays. That is why you should use them if possible. No matter what questions you may have, it is very likely the hospital TPA desk can help answer it.
Another great way to have your questions answered is to contact Onsurity’s Good Doctors Team. If your employer has subscribed to Onsurity’s affordable employee healthcare benefits, you can access our Good Doctors Team at any time. The team can help answer all your questions, and guide you through claiming your employee health insurance. That’s just one of the many great benefits of health plans with Onsurity.
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