Community › Forums › Legal Advice India › Cataract surgery limit with Star Health
- This topic has 6 replies, 4 voices, and was last updated 1 year, 4 months ago by
Alphaguy415.
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UUser_019355ee
PARTICIPANT
February 16, 2025 at 5:13 amI have the Star Health Assure Plan and recently inquired about cataract surgery coverage. Customer care mentioned that thereβs no specific limit on the surgery cost and even there is no limit mentioned in policy. Iβm considering getting a trifocal lens, which costs around βΉ1.25 lakh per eye.Has anyone undergone cataract surgery with this plan and successfully claimed for a high-cost lens like trifocal? Were there any hidden caps or restrictions during the claim process? Would really appreciate any insights or personal experiences!
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NNiharikarider869
PARTICIPANT
February 16, 2025 at 5:51 amI have heard most insurers restricting cataract surgery cost to the cheapest monofocal lenses.Β Β
There is a clause in all policies that only customary and reasonable charges would be applicable. This clause is as vague as it can get and used to deny higher cost lensBest is to check with the hospital on what amounts typically get approved.Β
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AAlphaguy415
PARTICIPANT
February 16, 2025 at 6:31 amFinancial planner here + I recently got my cataract surgery done in December through Star. Star has a fixed sub-limit for specific surgeries which varies from policy to policy + they permit only mono-focal lenses and not the others .i.e. bi-focal/tri-focal. Though i had change my product from FHO to assured 1.5year back with increased SA from 4Lac to 10Lac, they considered only 4Lac for this operation. I got approval for only 30,000 & not 35,000 i had to pay the balance amount. Had they considered my new policy i would have got a sub-limit of 45,000.Here’s what i suggest schedule a surgery & get your medical done & let the hospital send the quote for pre-approval, if it is approved you can go ahead with the surgery. Else you might have to downgrade the lens.
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UUser_019355ee
OP
February 16, 2025 at 7:00 pmIs the limit of 45000 mentioned in the policy for Assured plan. I don’t see the limit in my policy. Can you please confirm?-
AAlphaguy415
PARTICIPANT
February 17, 2025 at 2:13 amYes…it is mentioned.
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UUser_019355ee
OP
February 16, 2025 at 7:11 pmAlso on the approval, usually a small amount is pre authorized before surgery. I am worried if they approve the initial amount and then deny the full amount later.
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RRamyafalcon73
PARTICIPANT
February 16, 2025 at 11:20 amI know people will downvote and advise against it. I just have term insurance. Health insurance come with so much lumbo jumbo caps difficult to navigate. Just save that premium money and go for best care.
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