More insurance companies are setting up in-house Third-Party Administrators (TPAs), whose job is to directly settle claims with policy-holders. The idea is to eliminate approval delays for policyholders and payment delays for hospitals that happens when outside partners do the job.
The latest entrant is ICICI Prudential Life Insurance Company.
“A critical component of the service delivery process is claims settlement and by managing it directly, we want to ensure a fair and speedy resolution of claims,” said Poonam Bhardwaj, senior vice-president, underwriting and claims, at the firm which earlier had a tie-up with TTK healthcare services.
Last month, state-owned New India Assurance, Oriental Insurance, National Insurance and United India Insurance jointly appointed KPMG as the consultant to devise a roadmap for launching an in-house TPA.
TPAs were introduced by non-life insurance companies in 2001 to outsource their health claims processes. However, there is criticism of the in-house effort.
According to Dr Nayan Shah, managing director, Paramount Health Services (TPA), “Unlike an insurer’s in-house TPA, an IRDA licensed TPA is more answerable for rejecting genuine claims or if the claim turnaround time is high.”