Is Robotic Surgery Covered Under Health Insurance?

Posted on: May 24, 2022 | | Written by:

Is Robotic Surgery Covered Under Health Insurance?

Robotic Surgery Coverage under Health Insurance

The type of surgery performed with the help of tiny tools attached to a robotic arm is known as robotic surgery. It facilitates surgeons to perform complex surgical procedures with better precision, control, and flexibility as compared to traditional techniques. The movement of the robot is controlled by the surgeon, while sitting at the computer station. This technique is, mostly, required for brain surgery, heart replacement surgery and cancer of vital organs amongst other conditions. It is an expensive procedure in India and the cost depends on the type of surgery and the city where the surgery will take place.

Do health insurance plans in India cover robotic surgery?

Yes, health insurance plans in India cover the cost of robotic surgery. According to the guidelines issued by the Insurance Regulatory & Development Authority of India (IRDAI) in 2019, all health insurance companies have to mandatorily provide coverage for robotic surgeries. Hence, every insurance company covers robotic surgery costs in at least one of their plans under modern treatment. Some of the coverage for a robotic surgery includes the cost of hospitalization, surgery fees, doctor’s fees, nursing charges, ICU charges, etc. Pre-hospitalization and post-hospitalization costs associated with the surgery are also covered. A few insurance companies may also cover the cost of the ambulance services used to transport the patient to the hospital.

Some conditionsapplicable for robotic surgery coverage under mediclaim policy

Mediclaim policies cover robotic surgeries only if the surgery has been advised by a qualified surgeon trained in the technique. Unless it is recommendedby a qualified surgeon, insurance companies will not process the claim. Also, if the surgeon recommending robotic surgery is not trained in the technique required to perform the surgery, the claim might get rejected. The coverage for robotic surgeries may be subject to sub-limits, which means that the insurance company will cover the cost of robotic surgery as per the pre-specified limit. The remaining expenses will have to be paid by the policyholder.

What is the waiting period for robotic surgery

Robotic surgeries are not covered under health insurance plans from day 1. Policyholdershave to wait out a pre-defined waiting period to avail coverage for robotic surgery. The waiting period may vary as per the disease or medical condition that requires a robotic surgeryand also as per the terms and conditions of the mediclaim policy purchased.

Conclusion

Robotic surgery is a precise, less invasive technique of performing complex surgeries. However, the surgery can be performed only by trained surgeons and it is highly expensive. But, mediclaim policies in India cover the cost of robotic surgery. However, do remember to check the sub-limits, co-payments, and other terms and conditions for the surgery before buying a policy. Also, do not forget to research and compare health insurance for robotic surgery online before choosing the best plan for yourself.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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