TPAs and insurers: who is who
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हिन्दी में पढ़ेंQuick answer
Your insurer sells and pays your policy. A TPA is the company the insurer hires to process claims — it is often the name on your health card and the desk you deal with at the hospital, but the money and the decision are the insurer’s. HealAssist lists both, as separate categories.
The name on your health card is often not the name of your insurance company. That is not a mistake, and it confuses people at exactly the wrong moment — the hospital desk.
Who does what
| Who | What they do |
|---|---|
| Your insurer | Sells you the policy, holds the cover, and decides and pays the claim. |
| The TPA | Is hired by the insurer to run the claim: the card, the paperwork, the pre-authorisation desk, the hospital contact. |
| The hospital | Treats you and bills whoever is settling — cashless through the TPA, or you. |
Why does the difference matter to you?
Because you will be asked for both. The hospital wants the TPA card and the TPA’s pre-authorisation; the cover and the limits are the insurer’s. Knowing which is which saves you from being sent back and forth between two companies who each believe you should be talking to the other.
And because a rejection tells you where to go. If the pre-authorisation is refused on paperwork, that is the TPA. If it is refused on cover — a sub-limit, a waiting period, an exclusion — that is the insurer’s policy talking.
How HealAssist lists them
HealAssist keeps four kinds of payer: private insurers, TPAs, central government schemes and state government schemes. You can browse the directory by category, and what you see is live — HealAssist does not publish a fixed list of partners that quietly goes stale.
TPA questions
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