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Glaucoma Surgery Under Medicare or Health Insurance- 100% Cashless

Glaucoma surgery is a medical necessity and hence covered by health insurance and medicare policies. To learn all about the terms and conditions of the insurance policy, talk to the experts.

Glaucoma surgery is a medical necessity and hence covered by health insurance and medicare policies. To learn all about the terms and conditions ... Read More

Glaucoma Surgery Treatment Insurance Claim

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Benefits of Choosing Pristyn Care Treatment with Insurance

Is Glaucoma Surgery Covered by Insurance?

Glaucoma is a serious condition that can cause permanent damage to the optic nerve and lead to blindness. Thus, the treatment of glaucoma is considered a medical necessity, and it is covered by all health insurance policies.

To get the treatment covered by health insurance, the condition should be symptomatic and advanced to a stage where eyedrops and medications cannot manage the progression of the disease. The following symptoms indicate that glaucoma has advanced to a severe stage and most likely requires surgical treatment-

Severe headaches that don’t go away with medicines
Patchy blind spots in the peripheral vision
Difficulty seeing things in the central vision
Severe eye pain with halos appearing around light sources
Redness in the eye

If the patient’s peripheral vision has these symptoms, glaucoma has most likely advanced to a severe stage where it cannot be managed by medications and surgery is required.

• Disease name

Glaucoma

• Surgery name

Trabeculectomy/ Glaucoma Implant Surgery / MIGS

• Duration

1 to 2 hours

• Treated by

Ophthalmologist

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How to get Glaucoma Surgery under Insurance?

Both, health and Mediclaim insurance policies cover the cost of Glaucoma Surgery .However, it is advised to choose an insurance policy that provides extensive benefits at an affordable price. At Pristyn Care, you get not only the best treatment for Glaucoma.but also a hassle-free experience during filing the health insurance and Mediclaim. We take care of the complete procedure, including insurance-related paperwork, of getting approval on an insurance claim. This is to ensure that the patient nor their family members have to face any additional hassles.

1 Intimation

All you need to do is to fill a pre-authentication form along with relevant insurance documents for availing cashless treatment at our partner hospital.

2 Approval/Rejection

Your pre-authentication form is approved or denied based on the terms and conditions of your health insurance policy.

3 Hospitalisation

Hospitalisation can be done based on pre-authentication approval. Hence, it is advisable to finish the pre-authentication procedure beforehand.

4 Claim Settlement

At the time of discharge, we will coordinate and settle your bills directly with the hospital and insurance provider.

1 Hospitalization At Non Network Hospital

If hospitalised at a non-network hospital, you don't need to pay the medical bills. Pristyn Care will settle the bills with the hospital on your behalf.

2 Register A Claim

To register a claim, please fill in the claim form with all your receipts, reports and relevant documents received from the hospital at the time of discharge. We, at Pristyn Care will help you claim reimbursement from your health insurance company.

3 Verification

We will share all your claim-related medical documents in original with your insurance provider to check if everything is in order.

4 Claim Settlement

We will coordinate with your insurance company to reimburse the claim amount to your registered bank account. You can later pay back that amount to us as per the policy terms and conditions.

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Expenses Covered by Health Insurance and Medicare Policies

In general, the expenses covered by health insurance and medicare policies are almost the same. Some of the major expenses that are payable by insurance include the following-

Hospitalization expense which includes admission fees, bed charges, room rent, medical consumables, ICU charges, OT charges, nursing fee, etc.
Pre and post-surgery hospitalization expenses, such as pre-surgery consultation and follow-ups.
Ambulance cost is also covered in the policy, usually up to Rs. 2,000.
Cost of medicines given to the patient during the stay.
Surgeon’s fees, anesthetist’s fees, and anesthesia costs.
A second opinion from another doctor.

The insurance policies can be customized according to the buyer’s requirements. Thus, it is always recommended that the patients compare different policies and create a plan that can fulfill their medical needs under all circumstances. The add-on feature is also very helpful to get ample coverage for various kinds of treatments.

All Major Insurances Accepted

What is Medicare? What is the difference between Medicare and Health Insurance?

People looking for health insurance can opt for either Medicare or medical insurance (generally referred to as health insurance). Medicare is usually designed for individuals who are 65 or above, whereas health insurance is for people of all age groups.

The key difference between medicare and health insurance is that medicare provides full coverage for both medical and surgical treatments. Unlike this, health insurance policies mostly provide coverage for surgical treatments, which are considered a medical necessity.

Medicare policies offer global coverage, but such policies are not offered by most insurance companies. Only limited insurance providers, such as Tata AIG, offer these policies. The Indian government has also released a medicare scheme- “Ayushman Bharat-National Health Protection Mission,” to provide free coverage of up to Rs. 5 lakh per family per year at all government and empanelled hospitals.

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Frequently Asked Questions about Glaucoma Surgery Insurance

Are all types of glaucoma surgeries covered by health insurance?

Usually, surgeries that are considered a medical necessity are covered by all health insurance policies. This includes daycare procedures and surgeries that require hospitalization. So, whether the patient is undergoing laser surgery or any other type of surgery for glaucoma treatment, they will be covered under insurance. Some insurers also offer dedicated plans to offer more comprehensive coverage.

Which expenses associated with glaucoma treatment are not covered by health insurance?

A health insurance policy won’t cover the non-medical expenses that incur during treatment. Such expenses include prescription drugs taken after discharge, medical devices, post-op consultations after a specified period (usually 30 to 180 days), etc. These expenses come under exclusions of the health insurance policy.

When can my insurance claim get rejected?

An insurance claim request usually gets rejected due to non-disclosure or wrong disclosure of the facts. The two main reasons for claim rejections are- Technicalities Issues- The patient didn’t file the request or failed to provide the required documents. Medical Issues- The treatment is not considered a medical necessity. Besides the above-mentioned scenarios, a claim request can also be denied by the insurer if the waiting period is not over yet.

Is it possible to claim insurance for glaucoma treatment multiple times?

Yes, a policyholder can claim a health insurance policy any number of times as long as the sum insured is not exhausted. The only limit is over the sum insured. Fortunately, most health insurance companies offer plans whose sum insured can be refilled or reinstated after a claim.

How to avail No-Cost EMI service at Pristyn Care?

To avail the No-Cost EMI service, the patient needs to make a request to our care coordinators. Our care coordinators assist the patients with formalities and verify the patient’s eligibility for the service. Once approved, the patient can choose a tenure to pay the treatment expenses through smaller and easily payable monthly installments.

How to Claim Insurance for Glaucoma Treatment?

There are two ways to claim an insurance policy- cashless and reimbursement claim. The steps to get these are explained below.

Cashless Claim Process

A cashless claim allows a patient to cover the hospital bill upfront. This type of claim is usually settled between the hospital and the insurers directly with minimal involvement of the patient. However, there is one condition that the patient needs to fulfill, i.e., the patient should get treatment from a network hospital of the insurance company.

The steps to get a cashless claim are-

Inform the insurance provider 3 days prior to the surgery.
Get the cashless claim form and fill in the required information.
Provide the necessary documentation and clinical evidence verified by a certified ophthalmologist.
Wait for approval.

Meanwhile, the insurer will directly coordinate with the hospital’s TPA team and inform them about the approval through a text message or email. If the amount sanctioned by the insurance company is less than requested, the patient can submit another claim request to get better coverage.

Reimbursement Claim Process

A reimbursement claim is the compensation paid by the insurer to the policyholder for the expenses incurred and paid during the treatment. This type of claim can be requested for both network and non-network hospitals. The claim process involves the following steps-

Choose a hospital and undergo surgery as scheduled.
Let the insurance provider know about the surgery within 48 hours of hospitalization.
The insurance agent will provide a reimbursement claim form.
Fill out the form and submit the documents required, including discharge summary, pre/post surgery evaluations, and other bills.
The insurance company will verify the documents and issue a check in the name of the policyholder.

The patient is notified about the approval through a message or email. One thing that the patient should keep in mind is that a reimbursement claim request can only be filed within 30 days of discharge. If delayed further, most insurance companies won’t approve the claim.

Contact Pristyn Care to Undergo Glaucoma Surgery With or Without Insurance

Pristyn Care is a patient-centric healthcare provider. Thus, our main goal is to make the surgical journey of the patients simple and hassle-free. It includes providing them the flexibility to choose a payment mode that is convenient for them.

Thus, we accept all health insurance policies and also offer other services such as the No-Cost EMI service to all patients. To avail the No-Cost EMI service, the patient needs to-

Apply for the service by making a request to the care coordinators.
Provide all the necessary documents and our team will check whether or not the patient is eligible for the service.
Once the request is approved, the patient can choose a tenure to pay the treatment expenses in smaller monthly installments.

Thus, the patient can undergo glaucoma surgery without worrying about the expenses, irrespective of insurance policy availability.