What are assistance service providers in Health Insurance?

Going through a health crisis yourself or that of a loved one can test even the strongest amongst us. There is the emotional toll it takes, and then there is the financial toll. This is where the protection from health insurance comes in, but it’s not as easy as just paying the insurance premium and everything falls into place on its own. There are many processes involved, and having an Assistance Service Provider (ASP), also known as a third party administrator (TPA), can make your life that much easier during trying times.

Going through a health crisis yourself or that of a loved one can test even the strongest amongst us. There is the emotional toll it takes, and then there is the financial toll. This is where...

Going through a health crisis yourself or that of a loved one can...

Health insurance should help you focus on recovery, not bills.

1 Crore Health Plans starting @₹18/day*.

We pay 100% of your hospital bills

From syringes to surgeries

No limit on hospital room rent

No compromises on recovery

UID: 5908|*T&Cs Apply

What is an Assistance Service Provider (ASP) in Health Insurance?

Health insurance companies hire assistance service providers to deal with the administrative tasks involved with processing insurance claims.

Here’s what assistance service provider do

Health card

A health card is, in most cases, the first step in the claims process. This card is issued by the assistance service provider. It carries details such as the policyholder's name, policy number, and ASP data.

Claims

An ASP handles the claim management process between the insurance company and the policyholder. This includes asking for and verifying documentation related to the claim. They may also ask for additional documents when needed.

Customer support

The assistance service provider offers 24/7 support to policyholders to clear any of their claim-related queries.

Hospital network

ASPs are constantly in touch with hospitals and healthcare providers to ensure that they are being added to the network of hospitals under them. This ensures that policyholders have a wider choice of hospitals where they can opt for cashless claims rather than going down the reimbursement route.

Value-added services

ASPs can go beyond their administrative work and offer much-needed value-added services to policyholders. These can include wellness programs, second opinion consultations, specialist consultations, ambulance services, preventive health checkups, etc.

Are ASPs required in the insurance sector?

The claims process can be complicated for a policyholder to navigate on their own. As such, an assistance service provider’s role is very valuable to both the policyholder and the insurer. Here’s why they have become beneficial to the insurance process:

They maintain documents and help the policyholders with their documentation process, which can otherwise be a very daunting task.
ASPs ensure that the claims process is smooth and efficient for both the insured and insurers.
Assistance service providers also work towards simplifying the claims process for the policyholders.

How do ASPs settle claims

Assistance service providers settle claims through two methods:

Reimbursement claims

The payment for the hospitalisation will have to be made upfront by the insured, as the hospital chosen is not a part of the network hospitals
The insured will have to save documentation, including medical bills and diagnostic reports, and submit it to the ASP
The ASP will then verify the documents, which will then be forwarded to the insurance company
Once approved by the insurer, the ASP will then reimburse the expenses to the insured through bank transfer or a cheque

Cashless claims

The insured will have to choose a network hospital for treatment
The hospital then contacts the assistance service provider regarding the treatment. The assistance service provider then verifies the policyholder's eligibility for said treatment
Post-verification, the assistance service provider will release the pre-authorisation, which allows for the treatment to go forward without payment from the policyholder
Post-treatment, the assistance service provider settles the bill directly with the hospital

What are the differences between an ASP and an insurance company?

ASP	Insurance Company

Focuses on administrative tasks related to the claims process	Provides insurance coverage, collects premiums, and underwrites the policy
Liaisons between the hospital, the insured, and the insurer. Gathers documents and verifies said documents for the claims process	Approves claims based on the verification carried out by the ASP
Bears no financial risks as its main task is administrative	The final authority that pays out the claim and bears the financial risk
Deals with the insured for enquiries related to the claim, network hospitals, and documentation	Deals with enquiries related to premium payout, policy renewals, and the nitty-gritty of the policy

Frequently asked questions

Written by Roocha Kanade

2.5K Linkedin Followers

Reviewed by Dr. Harshita Dahiya

Health Insurance content enthusiast who turns complex topics into easy, binge-worthy reads—fueled by SEO, creativity, and way too much chai! Loves juggling multiple projects, cracking impossible deadlines, and sprinkling humor into the mix. When not geeking out over digital trends, you'll find her lurking on Quora and Reddit, planning the next getaway, or passionately decoding all things health and insurance!