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Does Health Insurance Cover Robotic Surgery?

Complex treatments have become easier for doctors to conduct as a result of medical innovation. One of the numerous breakthroughs made possible by advances in medical technology is robotic surgery. In cancer and general surgery, it has become very prevalent. If you’re wondering if robotic surgery is covered by Indian health insurance, keep reading.

What Is Robotic Surgery?

Robotic surgery is a type of surgery that uses microscopic instruments coupled to a robotic arm to execute the procedure. In comparison to traditional approaches, it allows surgeons to conduct difficult surgical procedures with greater accuracy, control, and flexibility. The surgeon directs the movement of the robot while sitting at a computer station throughout this procedure.

Robotic surgery is commonly used for brain surgery, heart replacement surgery, and cancer of the essential organs, among other procedures. In India, however, robotic surgery is a costly process. Robotic surgery costs typically range from Rs 1.4 lakh to Rs 11 lakh, depending on the type of surgery and the location of the procedure.

Cardiothoracic robotic surgery, for example, is more expensive than abdominal robotic surgery. Similarly, robotic surgery in urban places such as Delhi is more expensive than in tier 2 cities such as Varanasi. As a result, robotic surgery is out of reach for the majority of Indians.

Do Health Insurance Plans in India Cover Robotic Surgery?

Yes. Robotic surgery is covered by Indian health insurance coverage. All health insurance firms must give coverage for robotic procedures, according to recommendations established by the Insurance Regulatory and Development Authority of India (IRDAI) in 2019. As a consequence, under current medicine, every insurance company covers robotic surgery costs in at least one of their plans.

The cost of hospitalisation, operation costs, doctor’s fees, nursing charges, ICU charges, and other expenses are covered for robotic surgery. The surgery’s pre-hospitalization and post- hospitalization charges are also covered by the plan. Ambulance services required to transport the patient to the hospital may also be covered by some insurance carriers.

Conditions for Robotic Surgery Coverage Under Health Insurance Plans

Only if the procedure is recommended by a qualified surgeon who is trained in the method is it reimbursed by health insurance. Insurance companies will refuse the claim unless a qualified surgeon recommends it. Furthermore, the claim will be denied if the surgeon who recommends robotic surgery is not trained in the methodology necessary to undertake the procedure.

Furthermore, robotic surgery coverage may be subject to sub-limits. This implies that the insurance company will pay for robotic surgery up to a certain limit. The policyholder will be responsible for the remaining costs. If a sub-limit of 1% of the sum insured applies to robotic surgery and the total insured is Rs 10 lakh, the insurance will only cover surgery costs up to Rs 1 lakh.

Health Insurance Waiting Period for Robotic Surgery

From the beginning, health insurance policies do not cover robotic procedures. Instead, policyholders must wait out a set amount of time before receiving coverage for robotic surgery. The length of the waiting period varies depending on the sickness or medical condition that necessitates robotic surgery. If robotic surgery is necessary for knee replacement surgery, for example, a waiting time of two to three years may apply.

However, if the insured was diagnosed with a medical condition that required robotic surgery before to acquiring the coverage, the pre-existing disease waiting period will apply. This is because the sickness or medical condition in question will be regarded pre-existing. Pre-existing conditions are usually covered by health insurance policies after a 2- to 4-year waiting period.

Summing It Up

Robotic surgery is a more precise, less intrusive, and flexible way to execute difficult procedures. However, because the procedure can only be performed by experienced surgeons, it is extremely costly. Thankfully, Indian health insurance policies covers robotic surgery.

Before purchasing a coverage, make sure to verify the sub-limits, co-payments, and other requirements for the procedure. Also, before picking the best plan for yourself, compare health insurance for robotic surgery online.

Read More: Why Retirement Financial Planning Is Important

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