Ramesh Bhatt · Total Knee Replacement — right
Ophthalmologist notes show reduced visual acuity, glare while driving at night, and slit-lamp findings consistent with age-related nuclear cataract in the right eye.
- 1Cataract diagnosis is clinically consistent
Ophthalmologist notes show reduced visual acuity, glare while driving at night, and slit-lamp findings consistent with age-related nuclear cataract in the right eye.
94% - 2Day-care eligibility is clean
Fortis Memorial is a cashless network hospital, cataract with IOL is a listed day-care procedure, and the waiting period is satisfied.
95% - 3Cataract sub-limit caps approval
Policy pays up to ₹40,000 per eye for cataract. The quoted package is ₹60,000, so the family should expect roughly ₹20,000 at discharge.
91% - 4Lens upgrade must remain transparent
Base monofocal IOL is admissible within the package. Multifocal or toric premium lens upgrade, if selected, is payable by the family beyond the cataract cap.
88%
- Visual acuity: right eye 6/24, improves poorly with refraction.
- Slit-lamp: nuclear sclerosis grade III, right eye.
- No diabetic retinopathy noted.
- Monofocal IOL package selected; premium lens upgrade discussed separately.
“Cataract surgery with intraocular lens is covered as a day-care procedure subject to the per-eye sub-limit stated in the policy schedule.”
“The maximum payable for cataract treatment is ₹40,000 per eye, inclusive of surgery, standard IOL, OT, medicines and day-care charges.”
“Items such as admission kits, attendant charges, registration fees and certain consumables are not payable under standard indemnity.”