How To Claim Cashless Health-Care Facility From Two TPAs?

In an era of ever-increasing healthcare costs, people are looking for convenient and efficient ways to manage their healthcare costs. One such solution that is gaining popularity is the concept of cashless transactions facilitated by third-party administrators (TPAs).

Cashless TPA, also known as Cashless Claims Management Service, acts as an intermediary between policyholders, healthcare providers, and insurance companies. This serves to facilitate the smooth processing of insurance claims, eliminating the need for individuals to pay out-of-pocket and later seek reimbursement. But two he can get this feature from TPA?The answer is yes.

Also read: Calculate your hidden costs: Here’s why you need comprehensive health insurance

If you have two health insurance policies, you have the right to make a claim under one or both. It is important that the total hospitalization costs do not exceed the maximum coverage provided by one or both policies.

process

To simplify this process, we recommend initiating a cashless claim with your first insurance company and then claiming the remaining balance with your second insurance company. Upon discharge, the first insurance company will issue a final settlement letter detailing the total amount claimed and the amount paid by the policyholder. This document can be submitted to her second insurance company for reimbursement, along with medical documentation and original receipts for remaining balance.

Recognizing the potential benefits of policyholders using multiple health insurance plans, the Insurance Regulatory and Development Authority of India (IRDAI) has made significant changes to its rules and regulations. In the past, the IRDAI has required insurers to share the total medical costs proportionally based on each insurer’s insured amount, a practice known as a ‘contribution clause’ in health insurance. However, this requirement has been abolished and policyholders are now free to contact any insurer to resolve their claims.

Recent reforms implemented by IRDAI aim to make it easier for individuals to take advantage of multiple health insurance plans. By staying informed and understanding these changes, policyholders can navigate the complexities of coverage, protect their financial well-being, and ensure access to quality care when they need it most. increase.