r/IndianInvestment

TPA approved less amount for Cataract surgery under "Excess of Tariff". How to handle this without hospital conflict?

Hello everyone,

My wife is scheduled for cataract surgery (Phaco + Monofocal IOL, single eye) this week at a network hospital.

Policy: Corporate GMC (ManipalCigna / Medi Assist TPA).

The Issue: The hospital's estimate is well within our policy's per-eye capping. However, the TPA's initial approval is lower, deducting a significant amount under "Excess of Tariff/Package (Not to be Collected From Patient)".

The approval letter says the hospital shouldn't collect this difference from the patient, but I am worried they might still demand it at discharge. I strictly want to avoid any arguments or friction with the hospital management during her surgery.

Can I ask the hospital's insurance desk to submit a Justification Letter to the TPA to increase the approved amount before surgery?

Is it common for TPAs to enhance and clear this remaining balance during final discharge once the original lens barcode/sticker is submitted?

Any advice on how to handle this smoothly with the TPA and hospital would be a huge help. Thanks!

reddit.com
u/Longjumping_Cow_9039 — 3 days ago

Anyone else finding it hard to trust the current market highs and feeling scared to invest?

I spent a couple of hours last night looking over at news and checking the recent market trends, and instead of feeling happy about the green numbers, I just felt a knot of pure anxiety in my stomach and got depressed.

It feels like the Indian stock market has been hitting record highs, and everywhere you look on social media, people are bragging about massive returns and shouting about the next big bull run. But as someone just trying to build a stable future.

Every time I think about deploying my monthly savings into equity, a voice in my head warns me that a massive correction could be just around the corner due to global uncertainties.

I am very curious to know about your thoughts and experience that how are you managing your asset allocation right now without letting fear take over.

reddit.com
u/RevolutionNo962 — 7 days ago

need help in buying my first health insurance

19M, Delhi, no PED — which individual health insurance should I buy? Need help choosing plan + sum insured

Looking to buy my first individual health insurance. Here are my details:

  • Age: 19, male
  • Location: Delhi
  • Health: No pre-existing conditions, no family history of major illness
  • Employment: No employer cover, currently working decent salary
  • Dependents: None right now, may add parents separately later , confused between getting a individual plan vs getting a family floater one (read alot about getting individual only for now , open to discussion)
  • Budget: Flexible, optimizing for value not cheapest premium
  • i was thinking of my budget to be good value as of now cz i've never been to hospital till now as of the daily routine and okayish lifestyle so please suggest keeping that in mind too

What I want in the plan (non-negotiable):
No room rent limit, no co-pay, zero disease-wise sub-limits, restoration benefit, cashless network strength, CSR 95%+, ICR between 50-90%, PED waiting period ≤3 years, pre/post hospitalization covered, daycare covered, in-house claims settlement preferred over TPA

My questions:

  1. Sum insured —How much to get in Delhi? i'll leave this city soon probably shift to newer metro city only , Is super top-up a smarter play than going straight to any base?
  2. Which plan —
  3. Individual vs family floater — went with individual since parents would inflate premium and share the pool. Is this the right call long term?
  4. Buying channel — Ditto vs Beshak vs direct insurer — any difference in claim support experience?

Not looking for generic advice, want actual experience from people who've claimed or compared these recently. Thanks.

reddit.com
u/Knownassuraj — 10 days ago
▲ 10 r/IndianInvestment+1 crossposts

Massive continual fraud/scam(?) by Policybazaar and Bajaj general health insurance

TLDR - Policybazaar/Bajaj sold me a policy saying 0 copay everywhere, but issued one with 20% hidden copay.

I bought a Bajaj general health insurance policy from Policybazaar, and without asking me, they gave a 20% discount, but surreptitiously added a rider called "SelectNet Care Rider". Bajaj's own description of the rider (linked at the end) states a 20% copay (any reimbursement claim even in network, or any out of network claim). Policybazaar customer care gave me in writing that there is 0 copay (screenshot1), and Bajaj's customer service team also said there is 0 copay (screenshot2). This means both of them are completely unaware/lying. After showing the rider pdf to Bajaj from their own website, they suddenly changed, and essentially said "yes, there is 20% copay" (screenshot3). Policybazaar still disagrees that there is any copay even after showing them the rider pdf and the conversation with Bajaj. 

This means that Policybazaar/Bajaj has enrolled possibly unlimited persons to have 20% copay for Bajaj health insurance, without them knowing it, and this is truly fraudulent, and must be raised to the highest authorities in India. 

- If you or a family member has Bajaj health insurance, please check immediately if they have opted you for the "SelectNet Care Rider". 

- I have complete email/written documentation of all communication. How to raise this issue to the CEOs of both companies?

- How to raise this issue to the legal authorities in India?

- Are there any journalists willing to cover the issue?

SelectNet Care Rider - https://www.bajajgeneralinsurance.com/download-documents/health-insurance/SelectNet-Care-Rider-PW.pdf

UPDATE 1 (25/6/26) - Received another email from some "digital partner" of bajaj stating there is no copay. It had an entire email thread where different policybazaar persons were asking that specific bajaj team to confirm there was no copay. The head/CEO of policybazaar needs to talk to the head of the underwriting team at bajaj, since this issue affects every policy sold by policybazaar claiming 0 copay with the SelectNet rider, but hitherto only their unwillingness to do so has been evident.

UPDATE 2 (27/6/26) - Different teams at Bajaj seem to be saying different things, some say there is no copay, others say there is copay. I have written to IRDAI, Ombudsman, CEO of Bajaj, and the senior management at Bajaj Finserv (estimated the email addresses, didn't bounce). Lets see if anyone has the balls to look into it thoroughly.

u/stebahpla — 13 days ago