I have mediclaim policy from Oriental Insurance Co since 1992 for 5 lakhs and other from New India Assurance for 7.5 Lakhs under SCUM scheme with my spouse. However both the policies have set a limit of Rs. 40,000 for Cataract surgery even though I have been diagnosed with 1) Cataract Phaco with Panoptix IOL, 2) Pupilloplasty, 3) CTR Implantation for which a renowned hospital billed me as below for separately for each eye.
1) Cataract Procedure Cost. Rs. 27000/- which is approved by Oriental in their contract with Hospital
2) IOL Cost Rs. 49000/-
3) Pulilloplasty Rs. 6950/- after discount
4) CTR Implantation Rs. 1600/ after discount
Now in Claim No. 1 Oriental approved. Rs 36,000/- Only and balance Rs 48500 I had to pay
Claim No. 2 Oriental approved Rs.73,300/- Only and balance Rs.11250/- I had to pay
Surgery was done 1 week apart.
In my case I was advised Cataract with multifocal IOL + Pupilloplasty + CTR Implantation
So, I need your advice on:
How can Insurer Oriental approve and give different claim amount for each eye and how can I claim for reimbursement of balance amount I had to pay. Appreciate your guidance and help.
