Cataract Surgery - Urgent Help
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Friend has a corporate policy with Paramount TPA.
His father needs to have cataract surgery tomorrow (day care). Total cost is 55k for 1 eye (25k surgery, 25k lens cost). He called TPA who said that there is no cap/limit on this surgery.
But when he called hospital, they said they have some MOU/Agreement with TPA that only upto 30k will be paid by TPA in cashless mode. So he will have to pay 55-30k from pocket.
Is that how it usually is? Cashless mode has limits? What should he do?
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PPN Rate Hospital has agreed with TPA/ Insurance Companies is probably 30K for catract surgery. However they plan on charging higher than PPN rate ie 55K and asking you to foot the remaining bill. Kindly contact TPA. If the hospital is not agreeing then choose a different one.
Correct.
Bring it to the notice of TPA/Insurance Co. that you are being forced to pay extra amount.
55k is too much, you can first check with doctor what kind of lens he is using, you will have option to choose from them,
you can go with 30k lens so that its all covered.
ALSO check the policy documents for the exact limits it will be mentioned per eye
@drjpatwa
27k for toric lens and 25k for surgery. Total 55k
Policy document says no limit, but Hospital is saying that TPA will not pay more than 30k for cashless. Strange.
You still have time to decide the lens.
Not sure if you wish to delay this for 1-2 day if money factor
.
Also this is excluded from hospitalization admission, I guess day care means the same
By the way who is the doctor.
yes there is a limit……he has to pay extra amount or opt for the lower one…..and you are saying its a day care and not admitting to hospital
Your insurance company having the limitations not the hosiptal.
And also don’t do two eyes at a time you may take brake between and apply for two claims
Right. Same I did for my father’s both eyes. 1 eye at a time per financial year, advisable as per health and claim settlement, until its absolutely necessary both eyes at once.
55k for both eyes or single eye? All right, if both eyes then it is reasonable. For 25k, you might be getting Tecnis monofocal IOL, at least you should be getting it. If your budget is 55k, you should be looking at a decent progressive lens. 25k as medical fee is really exorbitant. But is he opting for laser surgery or traditional phaco technique? Ask him to get an Eyehance lens. Very very decent lens. But everything might be fixed as of now. I will wish him all the best
55k per eye. Manual (non-laser surgery).
Such is the pathetic state of affairs, hospitals doing open fraud.
It is an elective surgery, not an emergency surgery so tell the hospital to file a preauthorisation request with TPA for the 55k amount.
If it is approved, go ahead with 55k surgery.
If not approved, take it up with TPA why they didn’t approve when the policy states no upper cap on discount.
If hospital refuses to file a preauth for 55k surgery then choose a different hospital.
4th point is happening. Hospital filed a preauth for 30k , not 55k.
Saying standard package charges are 30k (and remaining amount is for higher-quality lens and hence has to be paid from pocket).
My mother had eye surgery as her power was -13 . So had to replace the lens with an artificial one.
They gave 3 lens options. 10,20,50k . There are 2 types of surgeries : I don’t remember the details but we chose the better one and it costed 14k. And chose the 50k lens. And yes only the operation cost was given by the insurance not the lens price. So they are partially correct. But operation cost must not be this high. Or they have increased in 3 yrs maybe
My grandfather had a cataract surgery just before lock down .Total price incl lens was 42k. Entire amt was paid by HDFC ergo via cashless claim .
There was another lens which mimics the human eye I forgot the name , the lens alone costed 80k and surgery 12k. Here Hdfc ergo denied the lens payment and told they will only cover the hospital bills
1) Doctor has advised no gas-cooking for few days. Is using induction heater fine then?
2) Doc has also advised to wear black sunglasses with closed sides (I think to protect from dust). Uncle has normal sunglasses but with open sides. Will this work or does he need to buy specific closed-sided sunglasses?
Patient needs to avoid dust, dirt,sunlight,smoke etc. Usually hospital themselves provide black sunglass with closed side, which needs to wear 7-10 days after surgery (better to wear as long as possible will 40 days). If not provided, it can be purchased from hospital itself as Its not much costly.
Not sure why gas cooking restricted, as no such restriction for my father both times.
Damn my mum needs to go through cataract surgery too. Local hospitals are quoting around 25k for the operation. Her TPA is some Medisafe or some, heard they provide up to 25k for three surgery, not sure. What’s the lens thingy here though? Don’t get it. I thought they just remove the cataract and let you go. At least that’s what they did when father had his done.
Sorry to revive this discussion..... its time for my mom to get her cataract done.... am getting confused... Dr google says that Monofocal + reading glass is best combio whereas my idea was to go for multifocal.... any one with recent experience.... pls share....
Thanks for the reply. Exactly this is what happened. The Dr said that she is not fit for Multi so suggested Mono.... but added that I can go with Eyehance.... bit more expensive but somewhere between Mono and Multi... will check with him once before the surgery in about 2 weeks.
Even if he goes with remburisment way there will be same cap so better check the policy terms and condition once