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How much can I claim for cataract surgery?

Cataract It is a medical condition that causes the lens to become cloudy and significantly affects vision. Cataract is one of the main factors leading to blindness in India.

There is no way to completely cure cataracts other than surgery. Therefore, you will eventually need to undergo cataract surgery to preserve your vision. Luckily, cataract treatment is covered by Indian health insurance regardless of which city, town or village you live in.

If your doctor recommends cataract surgery and you want your health insurance to cover the cost of the treatment, you also need to know how much you can claim. cataract surgery.

Today we will focus on the terms and conditions related to health insurance that limit the amount you can charge for cataract treatment. Let’s get started.

What is the insurance claim limit for cataract surgery?

Your health insurance company will determine the amount you can claim for cataract treatment. In the event that you end up having to have cataract surgery, you can purchase insurance, believing that it will cover the cost of the treatment. However, in practice things can be a little different.

Some insurance companies have claim limits for cataract insurance, but others may not follow the same rules. Alternatively, you can calculate the amount on a percentage basis. For example, at 10% of the sum insured, you can claim up to Rs. 250,000 for cataract surgery.

You should be aware of the fact that this is not a standard rule for all insurance companies. Some insurers, such as Digit Health Insurance, have unlimited coverage. Therefore, you can file a claim and the insurance company will pay the full amount incurred during cataract surgery.

Therefore, it’s important to compare insurance policies from various providers and purchase one that does not impose limits or sub-limits on your cataract surgery bill.

Also, please note that pre- and post-surgery treatment costs are not covered by insurance. This means that if you need medication, eye drops, or prescription glasses after cataract surgery, these costs will have to be covered out of your own pocket.

How do I claim insurance for cataract surgery?

Cataract surgery is a day surgery and does not require hospitalization for more than 24 hours. You can use one of the following methods to obtain a surgical claim:

Cashless billing services are usually available at insurance company network hospitals. If you have cataract surgery at one of these hospitals, you can use your insurance directly to pay for the treatment. The only thing required from your side is to contact the company representative in advance so that they can initiate the claim process on your behalf. You must present it and request a cashless application form. If all goes well, your claim will be processed and you won’t have to pay at the hospital.

Reimbursement requests are made before surgery is scheduled. You must notify your health insurance company in advance. A representative will help you through the process and you will need to provide the necessary documentation to confirm that you are indeed having cataract surgery.

The whole process can take about 2 days. You can pay for the treatment using your preferred method. During that time, your insurance company will process your claim and get your refund as quickly as possible.

How does the type of cataract surgery affect insurance claims?

As mentioned above, most insurance companies have limits on the amount that can be claimed under insurance. That’s because there are different types and techniques of cataract surgery available.

Claim limits are usually determined by considering the cost of conventional cataract surgery. However, in practice, most cataract patients do not opt ​​for conventional surgery. With advances in technology, people prefer to undergo minimally invasive cataract surgery. Because we use the latest technology, Cost of cataract treatment are also very different.

For example, if you want to undergo phacoemulsification cataract surgery, the cost will be around Rs. About 40,000 If you choose extracapsular cataract surgery, the cost will be about Rs. Rs. 40,000 Approximately Rs. 60,000 Also, if you decide to undergo Micro Incision Cataract Surgery or Femtosecond Laser Assisted Cataract Surgery, the cost will be approximately Rs. 85,000 Rs. 1,00,000.

As you can see, surgery can cost a lot depending on the technique chosen to perform the surgery. This is the main reason insurance companies place limits on cataract coverage. Inclusions and exclusions in the policy let you see the claim limits that are covered.


Finally, the only conclusion that can be drawn from the above information is that proper research is required when purchasing health insurance. Making hasty decisions increases the chances of choosing the wrong plan with minimal coverage for cataract surgery. For this reason, we cannot cover the full cost of cataract surgery. Therefore, it is essential to compare the policies offered by various companies and make an informed decision.

Some of the best companies that offer standard coverage for cataract surgery include ICICI Lombard, Care Health Insurance, Star Health Insurance, Oriental Insurance, SBI General Health Insurance and Bajaj Allianz Health Insurance. You can purchase a policy from any of these insurance companies. Use this policy to have cataract surgery with Pristyn Care.

Even better, if you don’t have health insurance, you can opt for free EMI while receiving treatment with Pristyn Care. Please make an appointment with us and talk to our medical coordinator to understand the conditions associated with cataract surgery.

https://www.pristyncare.com/blog/how-much-can-i-claim-for-cataract-surgery/ How much can I claim for cataract surgery?

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