THIRUVANANTHAPURAM: Insurance company denying claims in MEDISEP, insisting on avoiding the modern keyhole cataract surgery system and demanding to continue with the less expensive traditional method, is putting government employees and pensioners through a burden.
Traditional surgery is slightly less effective than keyhole surgery. Oriental Insurance Company, which implements MEDISEP, advises eye hospitals not to perform the relatively expensive modern Phacoemulsification surgery with mechanical assistance. They say that the traditional Manual small-incision cataract surgery (MSICS) is enough. Patients have to pay extra if Phacoemulsification is done. The government has signed an agreement with the insurance company for Phacoemulsification.
After the complaints were raised, the health department discussed and gave instructions, but it is alleged that the company is not listening. The company returned a claim for the phaco surgery the previous day as well. They rejected the claim with instructions as to why phaco is being done and manual is sufficient.
Through MEDISEP, which was implemented on July 1 last year, 25,000 phaco cataract surgeries were performed. The company, which did not have any problem in the first stage, has now come forward with objections.
Additional amount has to be paid by the patient
MEDISEP rates for phaco surgery is Rs 22,000 and Rs 15,000 for manual. Only Rs 15,000 will be allowed if the claim is paid for Phaco. Additional Rs 7000 should be paid by the patient and this leads to verbal disputes in hospitals.
Phaco is better