Cataract Treatment with Insurance at Pristyn Care
Yes, cataract surgery is covered by medical insurance in India. Insurance makes it easier for patients to cover the overall expense of cataract surgery. However, the terms and conditions around the coverage and the amount you can claim may vary for each patient.
Yes, cataract surgery is covered by medical insurance in India. Insurance makes it easier for patients to cover the overall expense of cataract ... Read More
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Cataract Treatment with Insurance at Pristyn Care
A cataract is a very serious condition that progresses slowly but can significantly impair vision. It affects the quality of life of the patient. And if left untreated for a long time, it can lead to blindness. Thus, the treatment is medically necessary.
As there is no natural cure for cataracts, surgery is the only option. The surgery can successfully restore vision. Thus, to ensure that the patient doesn’t lose vision, insurance companies offer ample coverage for cataract surgery in the base policy.
Typically, the cataract surgery cost with insurance in India ranges from Rs. 25,000 to Rs. 1,40,000 approximately. The actual cost may vary for each patient depending on factors like doctor’s fees, diagnostic tests, hospitalization fees, cataract lenses, post-surgery care, etc. If a patient has health insurance, they can get maximum coverage for the procedure and optimal care at their choice of hospital.
• Disease name
Cataract
• Surgery name
Phacoemulsification
• Duration
4 weeks
• Treated by
Ophthalmologist
Here, we are listing some of the popular health insurance providers in India. You can take a look at them and choose the best plan yourself.
Many other reliable insurance providers offer various health insurance plans according to the patient’s needs. Choose the plan most suitable for you.
Many people feel confused about health insurance and mediclaim policies, thinking they are the same. However, there is a key difference between these two types of medical coverage.
Mediclaim is a policy that offers specified financial protection for medical emergencies. An individual can only cover the treatment expenses if he/she is hospitalized. Unlike this, health insurance is a policy that offers comprehensive coverage for medical and surgical treatments, regardless of hospitalization. Health insurance allows an individual to cover expenses, such as annual health checkups, daycare surgery, OPD expenses, alternative treatments, post-surgery consultations, etc.
Furthermore, there is a limit on the hospitalization cover, stating that the expenses should not exclude Rs. 5,00,000. In contrast to mediclaim, a health insurance policy provides flexibility and the cover limit is calculated on the basis of age, city, number of members in a single plan, etc. Overall, health insurance policies are more beneficial for people compared to mediclaim policies.
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Here is a breakdown of the expenses that are usually covered by health insurance-
Insurance policies are offered to people so that they can get optimal care without worrying about expenses. However, there are some exclusions in the insurance plans which people are usually not aware of.
Please keep in mind that the following expenses or mediclaim limit for cataract operation are not covered by health insurance under any circumstance-
You’ll have to bear the cost of these on your own.
There are several clauses mentioned in insurance policies that can limit the amount of sum insured that can be claimed for cataract surgery or even exclude them from getting any coverage.
Most health insurance policies come with a waiting period of 2 years for cataract surgery coverage. This means that the patient has to wait for at least 2 years before he/she can file a claim. This clause is added to the policy to ensure that the policyholders don’t purchase the policy only to cover the expense of the cataract operation.
In corporate insurance policies, there may not be a waiting period clause in the insurance policy. To clearly understand the terms and conditions, it will be best to talk to the healthcare providers.
Insurance providers also put a cataract surgery insurance claim limit on the amount of the policyholders for cataract surgery. Any additional expense that is incurred during or after the treatment over the specific sub-limit must be borne by the patient.
The good thing is that the limit on claim amount is usually not the same across policies. So, while purchasing a health insurance policy, make sure that you go through the terms and conditions carefully and ensure that you can avail the full sum insured amount for most surgical treatments, including cataract surgery.
Thanks to modern technologies, cataract surgery is performed on a daycare basis. Thus, insurance policies cover the treatment under daycare procedures. This means that the patient doesn’t need to be hospitalized for 24 hours to get a claim.
The insurance companies offer two options to make a claim for cataract surgery- cashless and reimbursement and the process for each are slightly different.
To get a cashless claim from the insurance company, you are obliged to choose a network hospital to undergo cataract surgery.
Step 1- Inform the insurance provider at least 3 days before the procedure and fill out the cashless form. The hospital’s TPA team will coordinate with the insurance company to get the claim beforehand.
Step 2- The insurance company will send you an email or message or both to confirm that your claim request is approved.
If your claim amount is lesser than requested, you can always submit a second claim request to ask for more coverage for the procedure.
Step 1- Choose a hospital and schedule your surgery. Let the insurance company know that you’ll be undergoing surgery. You can also choose to inform the insurance provider within 2 days of admission.
Note- It will be best to inform the company earlier to avoid issues with the paperwork and claim process.
Step 2- Get the reimbursement form online or from your insurance agent. Fill the form and submit all paperwork, including discharge summary, pre and post-surgery evaluations, and other bills.
Step 3- As soon as the documents are submitted, the insurance company will validate them and reimburse the total amount of surgery at the earliest.
You will also get notified if your claim is denied. It should also be noted that there is a specified duration within which a patient can get a reimbursement claim. Typically, this duration is 30 days after surgery. This period may vary depending on the insurance plan.
If you have been diagnosed with cataracts and need to undergo surgery, you can always contact Pristyn Care. We offer best-in-class services for cataract patients. We also provide assistance to the patients to get the maximum amount of claim against the treatment.
As more than 80% of Indians don’t have an insurance policy, they can’t avail the benefits of health coverage. Thus, Pristyn Care provides affordable medical care along with services that reduce the expense of treatment at the patient’s end. The services include-
You can give us a call to learn more about our services.
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