Strabismus Surgery Under Insurance- 100% Cashless

How to Claim Health Insurance for Squint Eye Surgery?

A health insurance policy can be claimed in two ways- cashless and reimbursement claim. In both cases, the insurance company will cover the treatment expenses partially or completely. 

Cashless Claim 

A cashless claim allows the policyholder to seek treatment at a network hospital of the insurance company without paying any upfront fee. As the patient doesn’t need to pay anything during admission or discharge, the entire treatment is made cashless and the hospital bills are settled directly by the insurance company. 

The process to get a cashless claim is explained below- 

• Choose a hospital or clinic from the network mentioned in the insurance policy. 
• Inform the TPA (third-party administrator) desk at least 3 days prior to the surgery and provide the insurance ID/card. 
• Fill out the cashless claim form at the hospital and submit the form and all medical records at the TPA desk. 
• TPA will coordinate with the insurer and provide the required documents. 
• The insurer will approve the claim and settle the bills directly, excluding some expenses. 

In case the patient’s claim request is not approved, he/she can file a reimbursement claim. 

Reimbursement Claim 

This type of claim is made when the patient has already paid the expenses at the hospital. The reimbursement claim allows the patient to get compensation for the money paid for the treatment by showcasing the medical bills and other records spent on the surgery. 

The process to get a reimbursement claim is explained below- 

• Get in touch with the insurance company and provide the insurance ID/card. 
• Provide the bills, prescriptions, discharge summary, and other documents. 
• Obtain the reimbursement claim form from the website or get the form from the insurance agent. 
• Submit the form along with the required documents. 
• The insurers will verify the documents and approve the claim. 
• A cheque will be disbursed in the name of the policyholder, or the claim amount will be sanctioned in the patient’s bank account. 

The reimbursement claim request must be raised within 7 to 30 days of discharge. The time limit might be different depending on the policy. And the patient must know that non-payable items won’t be reimbursed. 

Expenses Covered by Health Insurance for Strabismus Surgery

The coverage varies for each patient depending on the policy purchased. Here is a breakdown of the general expenses that are usually covered by most insurance plans. 

• The doctor’s consultation and operating fee 
• Anesthesia and anesthetist fee 
• Hospital admission and discharge fee 
• OT and ICU charge 
• Nursing fee 
• Room rent (single, double, or sharing) on a daily basis
• Medicines and IVs given to the patient during hospitalization 
• Medical consumables, including syringes, sutures, catheters, gloves, masks, dressings, etc. 
• Post-surgery follow-up consultations 

Along with these expenses, people also have the option to customize the plan by choosing the add-on covers. This way, the patient can maximize the coverage for most surgical treatments.