Understanding The Process Of Health Insurance Claim Settlement

The claim settlement process is probably one of the most important aspects of a health insurance policy. In order to get a successful claim settlement, you can opt for any of the two types of the settlement process. Either you can go for a third-party administrator or through the in-house claim processes provided by the insurer.

Both the processes have their own set of advantages and disadvantages which we have mentioned below. This article is our effort in making you choose the right choice through which you can get a successful claim settlement.

Third-Party administrator 

A third-party administrator is basically the middleman, who can facilitate the settlement for your Health Insurance Policy. Generally, the TPA is appointed by the insurer who can help you to get your health insurance claim done from various hospitals. Now, if you are looking forward to your claim settlement process, you need to contact with the TPA as soon as possible.

Majority of the times, a third-party administrator is never responsible for the rejection of your claim, so you need to work according to such. Your insurer may also have a tie-up with a TPA company to get a successful claim settlement.

Advantages of third-Party administrator

Now, if you are looking forward to a third-party administrator, there are several advantages towards opting it. Down below are some of the advantages that you can reap from a third-party administrator:

  • The majority of the times, third-party administrators tend to have their own hospital networks which are generally larger than any other in-house department of your insurance company. While focusing entirely on the claim settlement process, it is always easy to work around with third party administrators.
  • Third-party administrators, with their only focus on claim management processes also tend to streamline the entire journey.
  • The overall time that is required for the claim settlement process is comparatively lesser than that of an in-house claim settlement department for the insurance company.

 In-house claim processing department

With an in-house claim settlement process, the insurance company tends to set up an entirely separate department just to deal with the claim settlement matters. Often the in-house claim department is also known as the Health Administration Team. With the case of in-house claim settlement, the insurance company shall be working directly with you along with the concerned hospital. If you are getting your health insurance policy done, chances are you will be getting a claim within the house. This is especially being done in the retail healthcare portfolio.

Advantages of in-house claim processing department

Being a branch division of the insurance company itself, in-house tends to outperform TPAs on several occasions. Down below are the examples of such instances where in-house claim processing department can be beneficial over TPAs.

  • Working with your insurer’s in-house claim processing department, you can easily look forward to a more assured claim. Being a policyholder with such insurance companies, you can also get special benefits from time to time which certainly deems to be beneficial.
  • One of the biggest advantages that you can get from in-house as compared to that of TPAs is the judgement on the claims. For instance, TPAs are only there to facilitate the entire process while on the other hand, if their claim seems legit, you can also get your health insurance claim. Often times, since the in-house department works directly with the company, the claim turns out to be hassle-free with very less paper-work.
  • While the TPAs are dependent on the insurer to get the policy claim done, the in-house works much more efficiently. So, you must compare these options carefully.

To conclude

Before wrapping up, it is very important to understand that whether you are opting for an in-house claim or TPA, both are the effective claim settlement process. But, in the end, it all comes down to your personal preferences. Before buying a health insurance policy, consider looking into the overall policy features, the claim settlement ratios and above all the waiting periods. Along with all the suggestions mentioned above, make sure to contact your financial advisor before you take any decision to buy a health insurance policy.