TPAs settle insurance claims more efficiently
09 June, 2008
Insurers engage third party administrators to control costs and reduce turn around time; TPAs also offer specialzed services such as ambulance referral, surgeon/specialist referral.
Why can't my insurer settle my claim directly with me? Why do I have to approach a third party administrator? Doesn't a TPA make policy administration, including the cost of my premium, more expensive?
Insurers generally tie-up with TPAs from the perspective of cost control and, more importantly, efficient customer service. This ensures customer satisfaction and reduced turn around time.
TPAs pass on their special rates advantage with hospitals to the insured. The insurers charge a small percentage of the premium for the specialized
services of TPAs such as ambulance referral, surgeon/specialist referral and also the claim process. In other words, TPAs act as a bridge between the customers and hospitals and ensure that customer's stay in the hospital is smooth and hassle-free.
I have lost my health policy document along with the cashless card and other papers. What should I do to get a new set? How much will the insurer charge me?
Generally, insurers do not charge the customer for loss of documents and card, which is known as a "policy kit" in insurance parlance. The insurer has a computerized record of the documents that can be easily provided to the customer. Regarding the card, the insurer will have to make a requisition to the TPA for replacing the original card.
We are shifting from Delhi to Mumbai for good. Can I get a cover for my luggage?
The transporter is a small time operator whom we chose because he is very economical. Since household contents are an assorted mix of old and new items, it would not be feasible for the insurer to use different yardsticks to measure the worth of hundreds of different items that comprise one's household cargo.
Cover for transporting cargo to another city comes under the category of marine insurance. Getting such a cover is subject to the packer-mover that one has engaged.
To get an all-risk cover for your luggage (cargo), you will have to employ the services of internationally recognized movers and packers who are affiliated to FIDI (Federation of International Furniture Removers or Fédération Internationale des Déménageurs Internationaux), which is the largest global alliance of independent quality international removal companies.
The FIDI alliance has over 500 international removal companies, all accredited by the FIDI Accredited International Mover standard (FAIM). When a moving company joins FIDI, it is automatically represented by the FIDI section of the association responsible for the region/country. In case no association is present in the region, the company would become a part of the Association of Direct Affiliates (ADA).
If one has employed the services of a small-time packer-mover who does not conform to any standards of service or excellence, then the insurer can only provide a basic external accident cover, which covers loss or damage to the cargo caused by accident of the vehicle used for transportation.
The insurer has a list of surveyors in all the major cities who can be contacted in case of an accident. They will reach the accident spot, survey the damage, take photographs and send the information to the insurer and the customer can then claim damages.
Getting an all-risk cover will not be possible as the possibility of cargo damage is high if it is not professionally packed.