Hyderabad ophthalmologists have raised serious concerns over what they describe as a growing nexus between healthcare aggregators, hospitals, and third-party administrators (TPAs). The doctors allege that this collaboration is leading to unethical practices, particularly in cataract surgeries, where a simple monofocal lens implantation is being treated as a disease treatment, while any other lens chosen to eliminate the need for glasses is classified as cosmetic surgery.
Unethical classification of cataract surgeries
According to the ophthalmologists, the classification of lens implants is being manipulated to maximize financial gains. When a patient undergoes cataract surgery with a standard monofocal lens, it is considered a medical necessity. However, if the patient opts for a premium lens, such as a multifocal or toric lens, to reduce dependence on glasses, it is categorized as cosmetic surgery. This distinction often leads to higher out-of-pocket costs for patients, as insurance coverage is denied for the so-called cosmetic procedure.
Dr. Ramesh Kumar, a senior ophthalmologist at a leading Hyderabad hospital, stated, “This practice is misleading and exploits patients who are unaware of the nuances. The choice of lens should be a medical decision, not a financial one driven by aggregators and TPAs.”
Role of healthcare aggregators and TPAs
Healthcare aggregators, which connect patients with hospitals and doctors, are accused of steering patients toward specific hospitals that have tie-ups with certain TPAs. These TPAs, in turn, influence the classification of procedures to maximize their commissions. The doctors claim that patients are often not informed about the full range of options or the financial implications of their choices.
“There is a clear conflict of interest,” said Dr. Anjali Sharma, another ophthalmologist. “Aggregators and TPAs are prioritizing profits over patient care. We are seeing cases where patients are pushed into unnecessary surgeries or into choosing expensive lenses without proper medical justification.”
Impact on patients
The nexus has significant financial and health implications for patients. Many end up paying thousands of rupees extra for lens implants that are not medically necessary, while others may avoid necessary surgeries due to high costs. The doctors urge patients to seek independent medical advice and to question the recommendations made by aggregators and TPAs.
According to estimates, the cost of cataract surgery in Hyderabad can range from ₹15,000 for a basic monofocal lens to over ₹1,00,000 for premium lenses. The difference in cost is often not covered by insurance, leaving patients to bear the burden.
Calls for regulation
The ophthalmologists have called for stricter regulation of healthcare aggregators and TPAs to prevent such malpractices. They suggest that all lens types should be treated as part of medical treatment, and insurance coverage should be based on medical necessity rather than arbitrary classifications.
Dr. Kumar added, “We need transparency in pricing and a standardized classification of procedures. The government should step in to protect patients from these exploitative practices.”
The issue has gained traction among medical associations in Hyderabad, with several groups planning to raise the matter with the Telangana State Medical Council and the Ministry of Health.
