Our 20-year-old son needed to fix his knee when he got injured while playing a football match for his university team. An MRI revealed his ACL (anterior cruciate ligament) had a grade III tear. According to the medical experts’ opinion, if he wanted to continue to play football, he would need to get it reconstructed. So, after in-depth research and meeting a few doctors in different hospitals about the options options available to get our son’s knee fixed, we finally zeroed in on a doctor and a hospital to carry out the ACL reconstruction surgery.
We applied for pre-approval from our third party administrator (TPA) as is the norm for availing the cashless facility for medical insurance. The expense estimated by the hospital was well within our insurance limits and we thought it was just a matter of procedure and would get the approval easily.
I was totally taken aback when I was told that the insurance company would only cover the package amount agreed upon by the GIPSA (General Insurance Public Sector Association) and the hospital came under the GIPSA preferred provider network (PPN). This information was given to us during the processing of our pre-approval request for cashless facility by our TPA / hospital. We were basically being asked what next did we propose to do?
