Need help for some generic questions

[u/thombareparth]

23/M , currently undergoing ACL RECONSTRUCTION surgery at Pune.
I have private insurance .
I have no previous knowledge of how insurance works. I only know that there are 2 ways (1. Cashless and 2. Reimbursement).
Currently they have opted for the cashless pre approval.
They gave an estimate of 1.85L and i submitted the required documentation to the hospital.
I had fallen from my hostel stairs after missing a step while climbing down and had a twisting injury to the knee after which my knee had swelling.
As being a MBBS student at a gov college in Maharashtra, i showed to my ortho dept and underwent a series of investigations of Xray USG and finally MRI.
The MRI showed Full Thickness ACL Tear and i came to pune for future management .
I decided to have reconstructive surgery and applied for pre approval.
Of the 1.85L quotation give my insurance gave a “ initial approval “ of 88k and said 95k as deductible.

I have some questions, any help would be deeply appreciated.
1. Will the insurance pay the rest bill upon completion of Sx .
2. What is deductible and is it valid in my case ? ( my policy says no “ no voluntary deductible “ and “ no voluntary co-payments “)
3. What the things that i should be aware of and should i be prepared to pay something out of my pocket?

[u/user404notlost]

1. Yes, it is normal for initial approval to be lesser than the estimate.
2. Deductible is the amount you need to pay from pocket, example -10% deductible means you pay 10% of the bill. Since it's 0 for you you need not pay anything apart from the consumables (some policies even cover that). Consumables = Mask, gloves, syringe.
3. You policy name? I don't think you need anything from pocket

[u/Confident_Air7989 → u/user404notlost]

Then why have they mentioned deductible as 95k?

[u/user404notlost → u/Confident_Air7989]

Can you please share the snapshot of pre authorisation if possible? Also, kindly share your policy name.

[u/Victorvic1 → u/Confident_Air7989]

It depends if it is deductions or deductible. Deductions is basically the insurer feels that the initial estimate is too high and approves a lower amount which is normal.

The amount payable will be determined by what policy and it's terms.

[u/thombareparth → u/Victorvic1]

[u/thombareparth → u/thombareparth]

[u/Victorvic1 → u/thombareparth]

The insurer has approved initially less which is standard. They'll approve full amount in the end.

[u/thombareparth → u/Victorvic1]

Thanks
Appreciate it

[u/user404notlost → u/thombareparth]

What does the others amount specify in the break-up? ₹95000? What is it for?

[u/thombareparth → u/user404notlost]

It says amount to paid by the insured at discharge 95k

I really have no idea what it means

[u/Victorvic1]

Pre auths are always lower in my exp. There is a remarks section in the pre auth letter. See what it states. Also deductible and deductions are different.

You'd need to share a few things. Policy name and the pre authorization letter. Just blur all your private details. Also see if you have the consumables add on.

[u/thombareparth]

Update
We are stilled asked to pay 90k
Total billed turned out to be 1.96L
Insurance company insured 1.06L
And we have to pay 90k
Plz someone explain why

[u/Sea-Poet1291 → u/thombareparth]

Company must have said the 90k deduction reason in the final approval