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!