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Does your health insurance cover robotic surgery?

Team AckoOct 1, 2024

Robotic surgery has come a long way in recent decades. Today, the medical industry can take advantage of this technology for a large variety of healthcare services that require attention to detail and accuracy. However, robotic surgery expenses are high. In case you are wondering if health insurance covers robotic surgery, read on to find out.

Contents

What is robotic surgery?
How much does robotic surgery cost?
Does health insurance cover robotic surgery?
How can health insurance be beneficial in robotic surgery?
What are the Conditions Applicable Under Health Insurance Plans for Robotic Surgery Coverage?
Does robotic surgery health insurance have a waiting period?
- Takeaway
Frequently asked questions

What is robotic surgery?

Robotic surgery is an advanced form of minimal invasive surgery that allows doctors to perform complex procedures with more accuracy, precision, and flexibility than traditional methods. Robotic surgery is beneficial in several healthcare specialties such as.

Cardiothoracic

Gastrointestinal

Gynecologic oncology

Urology

Otolaryngology (head and neck)

How much does robotic surgery cost?

Robotic surgery is a highly advanced form of surgery. Since this type of surgery is especially required for heart replacement, brain, cancer of vital organs, etc., the cost of robotic surgery is indeed expensive. Typically, the cost of robot-assisted or robotic surgery may range between Rs. 1.5 lakhs to Rs. 11 lakhs, depending upon the medical facility and the location. The cost can vary depending on the type of surgery and the location where the surgery is done.

For example, the cost of the procedure for cardiothoracic robotic surgery is expensive compared to abdominal robotic surgery. Likewise, the cost also differs between cities and tier-2 cities.

Does health insurance cover robotic surgery?

Robotic surgery was not covered by health insurance in the past. However, the Insurance Regulatory and Development Authority of India (IRDAI) issued guidelines to insurers to mandatorily include coverage for robotic surgeries. Insurers may cover robotic surgeries at least in one of their policies.

Health insurance that covers robotic surgeries provides coverage for hospitalisation, surgery fees, doctor and nursing charges, Intensive Care Unit (ICU) charges, etc. Some plans also cover pre and post hospitalisation costs. Read the terms and conditions of the policy to understand the inclusions and exclusions.

How can health insurance be beneficial in robotic surgery?

Healthcare technology is getting better with minimum errors ensuring minimal invasive surgeries. Besides, they offer precision and control over surgeries than conventional methods. However, these are early days of robotic surgeries and the costs are still high compared to traditional surgeries. With insurers offering coverage for robotic surgeries on certain plans, health insurance is an excellent financial cover when you need the most advanced healthcare treatments.

What are the Conditions Applicable Under Health Insurance Plans for Robotic Surgery Coverage?

Coverage of conditions completely depends on recommendations by an expert surgeon who is trained in the technique. The insurer will deny the claim if there is no recommendation from the expert.

Moreover, the coverage is subject to sub limits. This means the insurer will only cover the expense pre-mentioned in the policy, anything above and beyond that amount will have to be borne by the policyholder.

Let’s look at an example: For robotic surgery covered in a policy with a sub limit of 1% of the sum insured with the sum insured being 5,00,000; then only surgery expenses worth 50,000 will be covered by the policy.

Does robotic surgery health insurance have a waiting period?

Health insurance that covers robotic surgeries ideally has a pre-defined waiting period. It varies from insurer to insurer. Depending on the medical condition, the waiting may range from 1 to 3 years. It is better to check the fine prints of the policy before choosing the plan.

If the insured is diagnosed with a medical condition requiring robotic surgery before buying the plan, the waiting period for pre-existing diseases shall apply. The waiting period in such situations may vary between 1 to 3 years. However, ACKO health insurance policy does not have a waiting period. The only catch is that you need to reveal your medical conditions before you purchase the policy.

Learn more about waiting period for health insurance.

Takeaway

Robotic surgeries are changing the way operations are performed. With minimal invasive surgeries, patients are able to recover faster and the procedure is safer too. With specific health insurance plans covering robotic surgeries, they are slowly being accepted by customers. Choose a health insurance plan that offers coverages for advanced medical treatments such as robotic surgeries to keep yourself financially secured.

Frequently asked questions

Here are some common questions and their answers about robotic surgeries in health insurance.

Do all health insurance plans cover robotic surgeries?

No, not all health insurance plans cover robotic surgeries. You must read the terms and conditions before you opt for a plan.

Does health insurance cover robotic knee replacement?

Health insurance coverage for robotic knee replacement depends on the type of plan and benefits it offers. Read the terms and conditions of the policy to check if this type of surgery is covered.

What is the premium for a health insurance plan that covers robotic surgery?

The premium is based on several factors such as age, current health status, sum insured, number of add-ons, etc. It also depends on the type of plan you choose. Compare different plans online to know more about the features and benefits before you purchase a policy.

Are there any conditions applicable to health insurance plans for robotic surgery?

One of the primary conditions of the robotic surgery coverage is that the surgery should be recommended by a specialist robotic surgeon. The coverage may also be subject to sub-limits or co-pay. For example, if the sub-limit is 1% of the sum insured, and the sum insured is Rs. 20 lakhs. The policy will cover robotic surgery of up to Rs. 2 lakhs.

Is robotic surgery affordable?

Robotic surgeries are expensive since this is an advanced form of surgical procedure. Health insurance is an excellent financial tool to help you tide over the high cost for robotic surgery. Opt for health insurance that covers robotic surgery or include it as an add-on cover to ensure you have the access to high-quality healthcare such as robotic surgery.

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