Besides looking at the network of hospitals of TPAs, you should also look at information like the turn-around-time taken by TPAs in the settlement of your claims; digital enablement of the TPA; and the costs they have negotiated with the hospital
I have bought a health insurance policy for my parents. My mother was recently admitted to the hospital and when I tried to use the insurance cover, I I realized that the third-party administrator (TPA) does not have an extensive network of hospitals. So I want to change it. I do know that the Insurance Regulatory and Development Authority of India (Irdai) has allowed for switching of TPA. What factors should I consider when choosing my new TPA besides looking at its network of hospitals?
The simplest thing for you to do is to identify TPAs that have your hospital of choice empanelled and then switch to one of those. In fact, you could also ask the TPA desk at your preferred hospital about the TPA they find most efficient in terms of giving approvals.
Ideally, there is much more in- depth information that you ought to look at when making this decision, but that information is not publicly available, and you will need to speak with the insurers and TPAs individually, which can be time-consuming.
Besides looking at the network of hospitals of TPAs, you should also look at information like the turn-around-time (TAT) taken by TPAs in the settlement of your claims; digital enablement of the TPA; and the costs they have negotiated with the hospital. A TPA which helps in settlement of your claims faster would be more efficient.
You should also check if the TPA is digitally efficient in processing claims. If the TPA has the technology needed to process claims digitally in real time, your claim settlement is likely to be much quicker.
Another thing to check is the cost. The cost is not the money that you need to pay to the TPA but the hospital rates which TPAs offer at the time of claims. TPAs negotiate with hospitals to arrive at the cost of treatment and this cost varies across TPAs. So, you can get the quotation rates from different TPAs and choose one that not only has a wide network of hospitals but also offers low treatment rates.
Much of this information will need to be sourced through the insurer and the TPAs themselves. Each insurers has a panel of TPAs that they work with. You will have to choose one from your insurer’s list.