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Retinal Detachment Surgery Under Insurance- 100% Cashless

Retinal detachment surgery is covered by health insurance in all circumstances. The condition can significantly impact an individual’s vision and quality of life. Thus, all health insurance providers offer ample coverage for the treatment of a detached retina.

Retinal detachment surgery is covered by health insurance in all circumstances. The condition can significantly impact an individual’s vision and quality of life. ... Read More

Retinal Detachment Treatment Insurance Claim

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Benefits of Choosing Pristyn Care Treatment with Insurance

When Is Retinal Detachment Surgery Covered by Health Insurance?

Retinal detachment is usually covered by health insurance at all stages. Whether the patient has minor tears or holes or the retinal tissues have become completely detached, the insurance company will pay for the treatment as necessary.

Surgical treatment for a detached retina will be recommended if the following symptoms are present-

Reduced vision
Signs of infection in the eye, such as redness, swelling, or pain in the eye
Flashes or floaters in the field of vision
Discharge from the eye
Gradual loss of peripheral vision
A curtain-like shadow in the field of vision

Depending on the severity of the condition, different approaches would be taken for the treatment of retinal detachment. And the treatment coverage would depend on the proposed treatment plan.

To know the average cost of Retinal Detachment Surgery, get in touch with us and our medical coordinator will help you.

• Disease name

Retinal Detachment

• Surgery name

Pneumatic retinopexy / Scleral buckle

• Duration

2 Hours

• Treated by

Ophthalmologist

Retinal Detachment Surgery Cost Calculator

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How to get Retinal Detachment under Insurance?

Both, health and Mediclaim insurance policies cover the cost of Retinal Detachment .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 Retinal Detachment .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.

Medical Insurance Vs. Vision Insurance

Usually, eye doctors and hospitals accept both medical insurance and vision insurance. But there are a few differences between these policies.

Medical insurance covers the medical issues with the vision for which an individual may require treatment from an eye specialist or ophthalmologist. Unlike this, vision insurance provides comprehensive coverage for eye exams, corrective lenses, eyeglass frames, and contacts, and even offers discounts on LASIK eye surgery.

However, it should not be mistaken that all expenses incurred during treatment will get covered by the insurance policy. The individual will have to cover expenses that are excluded by the policy.

All Major Insurances Accepted

Types of Surgery Covered by Insurance

Both health insurance and vision insurance will cover the treatment expenses of the following types of surgery-

Laser surgery or photocoagulation
Cryopexy or freezing
Pneumatic retinopexy
Scleral buckling
Vitrectomy

All these surgical treatments are covered by insurance policies. However, there may be some clauses, such as co-payment, waiting period, capping limit, etc., on the policies.

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Frequently Asked Questions about Retinal Detachment Surgery Insurance

What is a co-payment clause in health insurance?

A co-payment clause refers to the arrangement in which the policyholder is liable to pay a portion of the medical expenses on their own, and the health insurance company will cover the remaining amount. The amount that needs to be paid by the policyholder might vary depending on the plan purchased.

What is a waiting period? How long does an individual have to wait to get retinal detachment surgery covered by insurance?

The waiting period refers to the amount of time the policyholder has to wait before filing a claim for a specific treatment. The waiting period usually varies for pre-existing conditions and newly developed conditions. It means if the patient already has a detached retina, he/she might have to wait for 1 or 2 years before filing a claim. However, if the patient doesn’t have the condition during the time of purchase, the waiting period clause is applicable.

Which documents are required for cashless claims?

The patient and/or the hospital needs to provide the following documents for cashless claims- Health Card/ E-Card Duly filled claim form Medical certificate/form signed by a certified doctor Payment Summary All bills and receipts Prescriptions cash memos Investigation reports

What is a reimbursement claim?

A reimbursement claim is given by the insurance company directly to the patient for the expenses covered by them personally for a surgical treatment. The patient pays the medical expenses of the treatment at the hospital and later files a claim request to get compensation for the amount paid.

How to file a reimbursement claim?

To file a reimbursement claim, an individual need to follow the steps below- Pay the treatment cost and get discharged as usual. Contact the insurance company and provide the insurance ID. Fill out the claim form and submit the required documents, including discharge summary, prescriptions, diagnostic test reports, etc. The insurance company will verify the documents and disburse a cheque in the name of the policyholder.

Is it possible to claim health insurance twice a year?

Yes, most health insurance policies get reinstated after a claim, which means the sum insured is refilled as soon as the limit is exhausted, and the patient can use the policy again. Some policies may have restrictions over the sum insured issuance after the policy is claimed.

Expenses Covered by Health Insurance

The following expenses are covered by health insurance policies-

Hospitalization expenses, including admission fee, bed charges, room rent, medical consumables, ICU charges, OT charges, nursing fee, medical consumables, anesthesia, etc.
Pre and post-hospitalization expenses, including initial consultation and post-surgery follow-ups.
Ambulance cost up to Rs. 2,000.
Cost of medicines given to the patient during hospitalization.
Surgeon and anesthetist fee
Technology used to treat the condition, such as laser machine, cryopexy probe, etc.
Second opinion from another doctor.

The health insurance policies can also be customized using the add-on feature that allows the patient to opt for additional coverage for various expenses that incur during the treatment.

How to Get Cashless Treatment for Retinal Detachment?

Retinal detachment progression is different in each patient. In some patients, the condition may progress slowly and take several years to advance. In others, the condition can progress rapidly and cause drastic vision loss in a short period of time.

If the patient chooses to get treatment at an early stage, the treatment is considered planned, and the claim is processed as usual. However, if the surgery is being performed on an emergency basis, the claim process will be slightly different.

Claim Process for Planned Treatment

Schedule retinal detachment surgery at the hospital and inform the insurer at least 2-5 days before the surgery.
Get the cashless claim form and submit the form through a letter, email, or online mode.
The insurance company will coordinate with the hospital’s TPA (third-party administrator) after receiving the claim form.
The TPA team will provide the required documents, such as medical reports, proposed treatment plan, etc.
The insurance company will verify the documents and send a confirmation letter through email or text message, which will be valid for 7 days from the date of issuance.
Get the surgery at the hospital as planned without paying any upfront fee.

Claim Process for Emergency Treatment

Retinal detachment is mostly treated as an emergency. The claim process in case of emergencies would be as below-

Notify the insurance company or Hospital’s TPA team during admission.
The Claim Intimation/Reference Number will be generated.
The hospital team will fill in and submit the cashless claim form to the insurer.
The authorization will be given to the hospital team by the insurers.
The insurance policy will cover all medical expenses, and the patient won’t have to pay anything during discharge.

In case the cashless claim request is rejected by the insurance company, the patient can consider filing a reimbursement claim to get compensation of the amount paid at the hospital.

Undergo Retinal Detachment Surgery With or Without Insurance At Pristyn Care

Getting proper treatment for eye problems is very crucial to preserve vision. Thus, Pristyn Care provides comprehensive care to patients who are diagnosed with retinal detachment. Whether or not the patient has a health insurance policy, we provide multiple payment options that allow patients to choose a convenient payment mode.

We accept all health insurance policies and offer services that reduce the patient’s expenses to some extent. These services include-

Free initial consultation with the best ophthalmologists in India.
Free cab service on the day of surgery to and from the hospital.
Flexible payment options, including cheques, credit cards, etc.
No-Cost EMI service to pay the expenses through monthly installments.

Avail No-Cost EMI Service for Retinal Detachment Surgery

Pristyn Care offers a No-Cost EMI service to all patients to make retinal detachment surgery affordable for everyone. The service divides the treatment cost into smaller and easily payable monthly installments.

To avail the No-Cost EMI service, the patient needs to-

Apply for the service by making a request to the care coordinators.
Provide the required documents to check their eligibility.
Choose a tenure to pay the monthly installments at his/her convenience.
Undergo surgery without worrying about the expenses.

Throughout the treatment journey, our care coordinators assist the patients with all treatment-related formalities to make everything simple and hassle-free.