What are the extra costs for cashless cataract surgery?

Dear Dilip T. Kayastha ji,

Cataract surgery is a common procedure to remove the cloudy natural lens of your eye and replace it with a clear artificial one, improving your vision. Here's what you should know about its cost and cashless options:

Cataract Surgery: Cashless Facility and Costs for One Eye

Cashless Cataract Surgery

• Yes, many hospitals offer cashless cataract surgery, provided you have a health insurance policy that covers it.
• Under the cashless facility, your insurance company directly settles the hospital bill, meaning you don't have to pay out of pocket (up to your policy limits).
• It's essential to check with your insurance provider and the hospital's TPA (Third-Party Administrator) department beforehand to understand the process and your eligibility.

Cost for One Eye

• The cost of cataract surgery for one eye can vary significantly in India, generally ranging from around ₹20,000 to ₹1,00,000 or more.
• This wide range depends on several factors, including:
  • Type of Hospital: Government hospitals, trust hospitals, and private hospitals have different fee structures.
  • Type of Intraocular Lens (IOL): Standard monofocal lenses are less expensive than premium lenses (e.g., multifocal, toric, extended depth of focus lenses) that correct astigmatism or offer a wider range of vision.
  • Surgical Technique: Traditional phacoemulsification (micro-incision) is common, while advanced laser-assisted (bladeless) surgery might be costlier.
  • City: Costs can differ between metro cities and smaller towns.
  • Surgeon's Experience: Highly experienced surgeons may charge more.

Potential Additional Costs Beyond the Cashless Amount

• Even with a cashless facility, certain expenses might not be fully covered by your insurance or may be in addition to the cashless package:
  • Upgrade to Premium Lenses: If your policy only covers standard IOLs, the difference in cost for a premium lens will likely be borne by you.
  • Room Category Upgrade: Choosing a room category higher than what your policy covers will incur additional charges.
  • Deductibles or Co-payments: Some policies have a deductible (an amount you pay before insurance kicks in) or a co-payment clause (a percentage of the bill you need to pay).
  • Non-Medical Expenses: Items like special food, consumables not directly related to surgery, or personal care items are often excluded.
  • Post-Operative Medications and Follow-ups: While initial follow-ups might be included, subsequent consultations or specific eye drops might be an additional cost if not part of the package.
  • Pre-operative Diagnostic Tests: Some specific tests might not be covered if they are considered outside the standard package.

How HexaHealth Can Assist You

• Cost Estimates: We can provide transparent, all-inclusive cost estimates for cataract surgery at various partner hospitals.
• Cashless & Insurance Support: Our team helps you understand your insurance policy, facilitates cashless approval, and guides you through the claim process.
• Ayushman Bharat Scheme: If you are eligible, we can assist you in availing benefits under the Ayushman Bharat Yojana for cataract surgery.
• Expert Doctor & Hospital Selection: We connect you with top ophthalmologists and leading hospitals offering advanced cataract surgery, ensuring quality care.
• Seamless Experience: From booking appointments to post-operative follow-ups, HexaHealth supports you at every step of your treatment journey.

It's always recommended to discuss all potential costs and insurance coverage thoroughly with the hospital's billing department and your insurance provider before the surgery. We are here to help make this process smoother for you.

To guide you better, kindly share the following details:

• Patient's Name
• City
• Is the cataract in one eye or both eyes?
• Has an eye specialist already advised cataract surgery?
• Do you have a health insurance policy? If yes, please mention the insurance company.

Based on these details, we will help you connect with the most suitable eye specialist and hospital and guide you regarding the expected cost and cashless treatment options.

Regards,
Team HexaHealth