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Cataract Surgery - Urgent Help

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Budhe-Baba

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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Topsey wrote:

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

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saymyname78 wrote:

55K for cataract surgery ? what kind of loot is going on …. In my city reputated doctors do it for 12-15 K , even cheaper if some contacts used .

Once again seeing this healthcare / insurance / cashless jumla , everyone trying to make money this way or other way .

Yeah my dad got it done for 13-14k with Bosch and Lomb lens around 1.5 years back.
They had cheaper lens alternatives which cost around 7-8k
Now for his second eye he again got a quote of 15k
Although they have costly lens options too but even upon asking they never clearly tell the difference and reasons for choosing costly ones all they say its better.
I don’t have much idea of procedures so can’t say about the price change due to that.

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baadshah wrote:

Thanks for the reply
Yes agreed that there will be upper limit either fixed limit and/or as percentage of policy coverage.
.
reasonable & customary clause – something new to learn rolleyes

Reasonable & customary charges clause. Suppose some hospital charges 5 lac rs. For Normal delivery, is it payable by insurance company (if policy has no capping whatsoever) ? Ideally yes but they don’t pay 5 lac under this clause… 

For cataract there is huge variation in rates. Some arw doing at 10k also while in delhi hospitals charge as high as 70-80k too !!! But cost of set up (land cost & other charges) is also high for delhi vs. Other city.

So in such scenario insurance company take decision under this clause…
@baadshah

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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?

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@baadshah
@getready
@dealyogi
@Ash-D

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Budhe-Baba wrote:

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?

@drjpatwa
@igen
@baadshah
@getready
@dealyogi
@Ash

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.

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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.

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Budhe-Baba wrote:

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?

@drjpatwa
@igen
@baadshah
@getready
@dealyogi
@Ash-D

I think by cooking they mean the hot vapours which come from food. So be it gas or induction will be a same thing.
Hospital provides those glasses. Don’t think sunglasses will work as closed sides are needed for protection from dust. Can get them cheap from the hospital or medical store I guess.
My dad was also advised to not to watch too much of tv.
Also to avoid rubbing also very precautious while bathing.
Don’t thing there’s much more.

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ithehappy wrote:

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.

Mostly the cloudy lens is removed and a new lens is placed. Most probably they did same for yori father but they didn’t told you about that.

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Budhe-Baba wrote:

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?

@drjpatwa
@igen
@baadshah
@getready
@dealyogi
@Ash-D

Strange they don’t gave 100 rupee glass

Did they give eye drop and time slots to apply
Eyerdrops is critical take take little extra care of eye for a week or so till next visit
After a week if he feels good then he can get normal routine with sunglass and eye drops for a month.

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baadshah wrote:

Strange they don’t gave 100 rupee glass

Did they give eye drop and time slots to apply
Eyerdrops is critical take take little extra care of eye for a week or so till next visit
After a week if he feels good then he can get normal routine with sunglass and eye drops for a month.

No , they did not give the glass. And we have called 15 pharmacies, none of them keep this closed-sided glass!! How strange.

At least the hospital provided the eye drops time slots.

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Budhe-Baba wrote:

No.

The TPA confirmed there is no cap and we can go for any MONOfocal lens. But the hospital is playing trick. Trick is that the hospital is raising total expense amount as 30k (instead of 55k) saying that that is the standard package. Standard package consists of base monofocal lens whereas we were opting for toric monofocal lens. This toric monofocal lens needs to be paid from own pocket. Why doesnt the hospital raise entire 55k amount and let TPA take the decision of agreeing/denying the claim?

Also, the corporate health insurance policy is just a 10 page PPT with no mention of minute details. @dealyogi

Then better go for different hospital because based on lens only the healing will happen yo can go upto 1.5 lakhs as well

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dealyogi wrote:

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.

My mom got her cataract surgery done 25 days ago, no black glasses. Only white glasses closed from all sides….. Cost 37k with the best Len’s available

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