Hi Everyone,
I’m looking for some guidance from people who’ve dealt with major surgeries and cashless insurance claims.
I have a planned surgery coming up at Apollo Hospitals for my father.
The hospital’s TPA team submitted a cashless claim to my insurance provider (corporate policy), and we’ve received a pre-approval for only about 60% of the estimated cost.
Now the hospital is asking us to deposit the remaining 40% upfront, saying that once the final bill is submitted and the claim is fully processed, they’ll refund any excess amount depending on what the insurance ultimately approves.
This is obviously a huge amount of money, so I want to make sure we’re doing the right thing.
I had a few questions for anyone who has gone through something similar:
- Is this the standard procedure when pre-approvals are low?
- Did you have to pay a large deposit upfront even under a cashless policy?
- What written confirmations should I get from the hospital before paying the deposit?
- What documents or email confirmations should I insist on?
- Any red flags to watch out for from hospital billing or TPA teams?
- Are there common charges in transplant surgeries that insurance typically rejects?
Also, if anyone has experience specifically with transplants and insurance claims, I’d really appreciate any insights or things to watch out for.
Thanks in advance for any help—this is a stressful situation and I just want to make sure we’re making informed decisions.
TL;DR:
Father has a planned transplant surgery at Apollo Hospitals. Insurance (corporate policy) has given only ~60% pre-approval under cashless. Hospital is asking us to deposit the remaining 40% upfront, saying excess will be refunded after final claim settlement. Looking for experiences on whether this is standard, how deposits/refunds usually work, what documents to secure, and what costs insurance typically rejects.