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Does your Health Insurance Plan Cover Robotic Surgery?
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Does your Health Insurance Plan Cover Robotic Surgery?

Robotic surgery is a comparatively newer form of medical treatment that has attained increasing popularity over the years. Doctors are now able to execute complex surgeries in a simpler manner, courtesy of widespread advancements. Robotic surgery is one of these advancements and is a pioneering invention that has become widespread throughout general surgeries and oncology divisions alike. Let us dig deeper to understand more about Robotic Surgery.

What do we mean by Robotic Surgery?

This is a specific kind of surgery done with assistance from tools that are linked to a robotic arm. It enables surgeons to implement complicated surgical and medical procedures with more control, precision, accuracy and flexibility in comparison to conventional techniques. With this surgery technique, surgeons control robot movements while stationed at specific computer-based workstations.

Robotic surgery is mainly necessary for heart replacement, brain and cancer surgery among various other conditions. Yet, this process is a costly affair in our country. The costs may hover between Rs. 1.4 lakh and Rs. 11 lakh, based on the surgery type and the city or location of the surgery in question.

For instance, suppose someone is getting cardiothoracic robotic surgery done. Then the cost will exceed something like abdominal robotic surgery. This procedure will also cost a lot more in metropolitan and Tier-1 cities in comparison to Tier-2 cities in India. Hence, the cost of the treatment is hard to afford for most citizens in the country.

Does Health Insurance Cover Robotic Surgery? 

Agreed, health insurance policies do offer coverage for the robotic surgery costs. Based on the regulations of the IRDA (Insurance Regulatory and Development Authority of India) in the year 2019, all health insurers have to compulsorily offer coverage for robotic and similar surgeries. Resultantly, each insurer offers coverage for the expenditure on robotic surgery in at least a single plan nowadays. Coverage for robotic surgeries encompasses costs of surgery, hospitalization, nursing, ICU costs, doctor’s fees and more. It also ensures coverage for post and pre hospitalization costs linked to these surgeries. Some insurers may readily cover costs of ambulance or transportation services for reaching hospitals. 

Points to consider for buying health insurance to cover robotic surgery

  • Robotic surgeries usually get coverage under health insurance plans only if surgeries are recommended by surgeons who are qualified in these techniques. 
  • Without such recommendations, insurers will not approve the claim in question. 
  • If the surgeon who is recommending the surgery does not have training in the necessary techniques for conducting surgeries, the claim will naturally be rejected. 
  • Coverage for these robotic surgeries may thus be subject to specific sub-limits or conditions. 
  • The insurance company will offer coverage for robotic surgery costs based on pre-fixed limits. The remaining expenditure will be paid by the holder of the policy. For instance, if the sub-limit is 20% of the sum assured and this amount is Rs. 5 lakh, then the policy will offer coverage for costs up to Rs. 1 lakh only. The remainder is payable courtesy of the policyholder. 

 

Waiting Periods for Robotic Treatments and Other Aspects

  • Robotic treatments do not have coverage under health insurance policies from the outset. 
  • Policyholders will have to wait it out for a pre-fixed waiting period in order to get robotic surgery coverage. 
  • The waiting periods may differ based on the medical conditions/diseases which require robotic surgeries. 
  • This waiting period may hover between 2-4 years in most cases. 
  • If the insured individual was affected by any medical condition that required robotic surgery prior to buying the policy, the pre-existing waiting period will be applicable. 
  • This is due to the fact that the medical condition will be perceived as a pre-existing one in this scenario. 
  • Robotic surgery is negligibly invasive and more precise and it can only be conducted by skilled and experienced surgeons. Hence, it is a costly affair. Hence it is a good thing that it is covered by health insurance policies. 

 

What You Should Check Before Buying Health Insurance for Robotic Surgery?

  • Co-payment clauses. 
  • Sub-limits for availing of treatment. 
  • Waiting periods and other surgery conditions. 
  • Compare health insurance policies in case of robotic surgery before finalizing one suitable to your needs. 
  • You should check the finer details carefully; for example, a claim being admissible for robotic surgery is dependent upon the disease necessitating the surgery. For example, if a knee replacement operation is required owing to conditions such as osteoarthritis which are degenerative, then there could be waiting period clauses in the policy. 
  • These surgeries may only be eligible for reimbursements if they are recommended by qualified and trained medical practitioners. Hence, the need for this type of surgery should be clearly highlighted by the doctor. 
  • This will save you from future hassles while claiming expenses on the same. 
  • The need for such a costly procedure is mostly verified by insurance companies while you are making the claim in question. 

 

Why do You Require Health Insurance before a Robotic Surgery? 

In robotic surgery cases, health insurance is a lifesaver. You can get coverage up to the amount required for surgery along with accompanying expenses including room rent, consultation charges and a lot more. You will find that your health insurance plan comes in handy for safeguarding your financial savings and position if you require this surgery. 

Conclusion

As you can see, robotic surgeries are immensely costly procedures. They require a sizable amount of money on account of their complexity and precision. Hence, covering these costs is otherwise difficult unless you have health insurance. Health insurance is the best possible solution for getting financial coverage for your robotic surgery needs.

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