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Does health insurance cover brain surgery?

Team AckoMay 22, 2024

The human brain is a complex and vital organ of the body. Any health complication to the brain can impact intelligence, body movement, senses, and behaviour. That being said, the brain is a delicate organ and is vulnerable to diseases and infections.

While some conditions affecting the brain can be treated with medicines, others need surgical intervention. Brain surgeries are costly medical procedures that can significantly impact your financial stability, especially in India's metropolitan cities. The expenses for brain surgery extend beyond the surgery itself and include tests, hospital stays, medication, and more.

To protect yourself from these substantial costs, consider acquiring health insurance coverage that specifically includes brain surgery coverage. But does health insurance cover brain surgery? Let’s find out.

Does

Contents

What is brain surgery?
When is brain surgery needed?
Types of brain surgery
What Are The Common Risks Of Brain Surgery?
What is the cost of brain surgery?
Does health insurance cover brain surgery?
Why buy health insurance online for brain surgery?
Is there a waiting period for brain surgery under health insurance?
Common inclusions under health insurance for brain surgery
Things not included under health insurance for brain surgery
- Takeaway
Frequently asked questions

What is brain surgery?

The term brain surgery refers to a surgical procedure that involves repairing the structural issues of the brain. Problems to the brain can include tumours, epilepsy or leaky blood vessels. There are different types of brain surgery, and the procedure is complicated and critical. Neurosurgeons carry out brain surgery with caution. New-age medical treatments allow surgeons to operate on the brain without or with minimal incision near or in the patient’s head.

When is brain surgery needed?

Brain surgery is needed to treat the below medical conditions within or around the brain.

Tumours

Bleeding

Aneurysm

Blood clots

Skull fracture

Nerve damage

Nerve irritation

Parkinson disease

Stroke

Epilepsy

Abnormal blood vessels

Fluid building in the brain

Pressure post head injury

Abscesses

Damages to Dura tissues

Types of brain surgery

Following are some of the most common types of brain surgery.

Neuroendoscopy: The surgeon makes small incisions in the skull to reach the defective parts of the brain to remove tumours.

Craniotomy: This type of brain surgery is performed on medical conditions such as brain tumours. The surgeon removes a part of a person’s skull in this procedure.

Deep brain stimulation: The surgeon makes incisions in the skull to insert a small electrode into the brain. The electrode, connected to a battery, sends electrical signals to the brain.

Posterior fossa decompression: Under this procedure, the surgeon makes a small cut at the back of the head to remove a small part of the bone located at the bottom of the skull. It helps create more space for the cerebellum to move and removes the pressure on the spinal cord.

Biopsy: The surgeon makes incisions in the skull to retrieve brain cells or tissue for a diagnostic test.

Thrombectomy and Cerebral Aneurysm repair: The procedure does not involve incisions to the brain or the skull. Instead, the surgeon guides a catheter through a large blood vessel in the groin to reach the brain vessels and identify the problematic blood vessel.

Endonasal endoscopic surgery: The procedure does not require incisions to the brain. The surgeon inserts an endoscope through the nose and sinuses to remove tumours.

What Are The Common Risks Of Brain Surgery?

Surgical procedures on the brain can be highly complex. Some common risks associated with brain surgery include the following:

Speech and memory issues
Muscle weakness
Vision problems
Balance and coordination issues
Seizures
Blood clots in the brain
Coma
Infections
Brain enlargement
A need for additional operations

What is the cost of brain surgery?

Surgery involving the brain, a vital organ, is an expensive procedure and could put a dent in your savings. Brain surgery costs in India may range between Rs. 2 lakhs to Rs. 10 lakhs, depending upon the severity of the condition. Moreover, the price can differ between cities and hospitals. For example, brain surgery performed in Chennai may cost more compared to tier-2 cities such as Karur.

Apart from the surgery, the cost of scans, diagnostic tests, and post-hospitalisation care needs to be factored into the overall expenses. Hence, brain surgery is expensive, and you need health insurance covering brain surgery to shield you against a high financial burden.

Does health insurance cover brain surgery?

Several health insurance plans in India cover brain surgery. Here are the details of the coverage.

Expenses incurred on hospitalisation

ICU (Intensive Care Unit) charges

Pre and post-hospitalisation costs

Ambulance services

Alternatively, you can opt for Rs. 1 crore health insurance policy offered by ACKO for holistic coverage. Our policy does not have a waiting period and no deductions during claims, making it an excellent choice if you want health insurance coverage for brain surgery.

Some insurers cover brain surgery under Critical Illness Plans. You shall receive a lump sum amount through the plan upon diagnosis of a critical illness that requires surgery of the brain. It is better to check the type of critical illnesses covered by your health insurance plan for wholesome insurance coverage.

Learn more about waiting period for health insurance.

Why buy health insurance online for brain surgery?

The conventional method of depending on middlemen to purchase a health insurance plan was a cumbersome task. New-age insurers such as ACKO offer a hassle-free process to buy health insurance online. Visit our website or mobile application to buy health insurance online almost instantly.

Here are some of the benefits of buying an ACKO health insurance policy online.

Liberty to buy health insurance directly from ACKO, thereby eliminating commissions.

With no middlemen, our operating costs are lower. Hence, you get tailor-made and affordable health insurance plans from us.

Quick paperless transactions help you to perform all tasks without hassles.

Get a Rs. 1 crore health insurance plan without a waiting period (subject to terms and conditions).

Zero deductions during claims. Things like room rent cap, copay, non-payable costs, deductibles, etc., are not capped when you buy health insurance from us.

An extensive network of hospitals and a customer support team are available around the clock.

Is there a waiting period for brain surgery under health insurance?

Several health insurance plans in India have a waiting period for brain surgery. But, that is not the case with ACKO health insurance. There is no waiting period and no deductions during claims. The only catch is that you must inform us about your past and current medical history before buying the plan. Declaration of your medical history gets you coverage from day one.

Ensure that you read the terms and conditions of the policy thoroughly before you purchase the plan. It is also essential to find out which type of brain surgery is covered under the plan to be sure about the coverage, and there are no surprises when you need the financial support the most.

Common inclusions under health insurance for brain surgery

Health insurance plans that cover brain surgery will usually bear the expenses of the following:

Hospitalisation costs: Most health insurance plans typically provide financial coverage for the expenses incurred during a hospital stay for brain surgery, including charges for the room, nursing assistance, and any other necessary medical treatments.
ICU costs: Brain surgery is extremely complex. The patient might need to stay in the ICU after the surgery. Health insurance plans usually cover the ICU charges for patients.
Diagnostic and imaging tests: Health insurance frequently includes the expenses of preoperative diagnostic assessments and imaging examinations like MRI, CT scans, and X-rays to evaluate the brain's state and plan the surgical approach.
Surgeon’s fees: Insurance generally includes the surgeon's charge for executing the brain surgery, along with fees for any aiding surgeons or experts participating in the process.
Anaesthesia services: Anaesthetic services essential during brain surgery, including the provision of anaesthesia and supervision of the patient's vital indicators, are usually included under health insurance.
Follow-up care: Insurance might cover postoperative care and rehabilitation services essential after brain surgery, like physiotherapy, occupational therapy, or speech therapy.

Things not included under health insurance for brain surgery

Every health insurance plan that includes surgery does not offer the same amount of coverage. You will have to carefully read the terms to learn about the specific exclusions. But some common exclusions include the following:

Cosmetic procedures: Health insurance typically doesn't pay for brain surgeries done solely for cosmetic purposes, like those that aim to change a person's appearance or improve their cognitive abilities.
Experimental or investigational procedures: Your insurance may not cover brain surgeries that are still being tested. These surgeries haven't been fully proven to work safely and effectively for the particular medical condition you're being treated for.
Pre-existing conditions: Certain insurance policies might not cover brain surgeries if they are related to health problems that were previously identified or persistent before the person got their insurance.
Out-of-network hospitals: Many insurance policies have extensive hospital networks. If you get brain surgery from a hospital outside this network, your coverage may be restricted or denied unless it's deemed medically necessary or an emergency.

Takeaway

Critical illnesses requiring brain surgery can be expensive. However, your health is of utmost importance. Ensure you get quality healthcare, especially if you are diagnosed with a critical illness. Get a health insurance plan that does not have a waiting period. Our Rs. 1 crore health insurance plan does just that. There is no waiting period as long as you inform us of your past and present medical conditions. It is crucial to opt for a health plan that covers all types of critical illnesses from day one.

Frequently asked questions

Here are some common queries and answers about brain surgery health insurance.

Does health insurance cover brain surgery for the tumour?

Some insurance policies cover brain surgery for tumours; however, you must check the coverage details before opting for the plan since not all insurers provide coverage for brain surgery.

What do you mean by pre-existing conditions?

Any medical condition, injury or ailment or related condition a person is diagnosed with before purchasing health insurance is known as pre-existing disease or condition.

Are there any criteria for purchasing ACKO’s Rs. 1 crore health insurance plan?

Our Rs. 1 crore health insurance plan is designed with a Zero Waiting period and Zero Deductions during claims. However, you must declare your past and current health conditions since they are criteria for purchasing our health plan.

What should I do if my insurer rejects my claims for brain surgery?

When an insurance company denies a health claim without justification, you can refile the claim. If the claim is denied again, consider contacting your insurer to resolve the issue and protect your rights.

What will happen if the cost of brain surgery exceeds the insured amount?

Your insurer will reimburse you until the maximum sum insured amount. When it expires, you must pay for the expenses from your pockets.

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Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.