Managing medical costs during hospitalization can be stressful. To help ease this burden, Suman Eye Clinic and Surgery Centre offers full cashless mediclaim support for cataract surgery.
Under a cashless facility, the hospital coordinates directly with your Third-Party Administrator (TPA) or insurer. The insurance company pays the approved medical bills directly to the clinic, requiring zero upfront deposits from you. Here is a step-by-step breakdown of how it works.
Step 1: Document Check at the Cashless Desk
When scheduling your surgery, visit our cashless desk and share your health insurance card, Aadhaar card, the doctor's prescription, and relevant diagnostic reports. We will review your policy details to confirm eligibility.
Step 2: Submitting the Pre-Authorization Form
Our billing desk coordinates with the surgeon to fill out the pre-authorization form. This form details the medical necessity of the cataract surgery, the planned surgical technique (phacoemulsification), and the calculated lens requirements. We submit this form electronically to your TPA.
Step 3: Receiving the Approval Letter
The TPA medical panel reviews the request to verify coverage. Once approved, they issue an initial pre-authorization letter defining the covered cost limit. This approval is usually received within 2 to 4 hours.
Step 4: Undergoing the Daycare Surgery
With the approval in place, you undergo surgery on your scheduled date. The stitchless phaco procedure takes 10 to 15 minutes, and you are discharged the same day.
Step 5: Final Settlement at Discharge
Upon discharge, we submit the final billing summary and discharge papers to the TPA. Once the final approval is issued, you settle only the non-medical expenses (such as registration fees or room kit costs) out of pocket, and you are free to go.
Tips to Prevent Cashless Delays
To ensure a smooth process, submit your documents at least 48 hours before your planned surgery. This gives the cashless desk ample time to handle any queries raised by the insurer and secure your approval in advance.