Most of the health insurance companies have a clause for not paying for multifocal lenses for cataract surgery. So if you are holding a health insurance policy, you can’t opt for premium lenses & will have to wear spectacles post cataract surgery.
Also most of the insurance companies do not mention the limit for cataract surgery in their policy document. Patient is being told NO LIMITS on surgical packages when they buy the policy. These companies than enter in to negotiations with hospitals & fix the surgical packages- these are network hospitals which sign the packages in the hope of getting larger volumes.
So now when patient reaches the network hospital, he can opt only for the package which the hospital has entered in to agreement with the insurance company. So he is deprived of the privilege of premium lenses for cataract surgery. Also patients with different amount of policy, say some one with 2 lakh cover & other with 10 lakh cover, both will be offered same package agreed & signed by the hospital- This is the situation if patient goes to network hospital for cashless treatment
But if the same patient goes for treatment to non-network hospital which has not agreed to sign meager package of the insurance company, he is entitled for premium surgery which will be reimbursed by the insurance company as there is no limit prescribed in the policy for surgical packages. Only issue here is patient need to settle the bill in the hospital & submit the claim for Reimbursement
I have written this blog for the benefit of the patients & their understanding of the claim process & how they can get maximum benefit of their policy- otherwise patient with 2 lakh cover & 10 lakh cover will be painted with the same color
Also, insurance agents who sell the health insurance policy, do not encourage reimbursement as it becomes their responsibility for the claim settlement.
That is how patients fall in the trap of the insurance company to go for cashless treatment as it is for their advantage as they have been able to enter in to agreement with meager surgical packages with many hospitals promising them larger volume of business
There is only one company- STAR HEALTH which has mentioned cataract package limit in the policy document when you buy the policy & cataract package limits vary depending on your policy amount. Whether you go for cashless or reimbursement, there is no difference in the claim amount.
Asian eye institute & laser Centre (AEILC) is an iso 9001-2008 certified eye hospital providing modern &fully integrated “Eye Care Services” and Pan-ophthalmology Services in Mumbai since 2004.