Is Robotic Surgery Covered Under Health Insurance?

Robotic surgery is relatively new. And the medical industry is taking advantage of it to provide a variety of healthcare services that need accuracy. Typically, a robotic surgical system is used by surgeons for minimally invasive surgery as it allows faster healing. Robotic surgery is used for more precision like tissue removal around large blood vessels, cancer involving vital organs, heart and joint replacement surgeries, and brain surgery, among others. Since the expenses for the surgery are quite high, health insurance provides coverage for this surgery.

What is Robotic Surgery?

Robotic surgery is a type of advanced form of surgery, which is conducted by using modern tools attached to a robotic arm. It enables surgeons to perform complex surgical procedures with more precision, accuracy, and flexibility than traditional methods. This advanced surgery is helpful for many healthcare specialists, including:

●Gastrointestinal
●Cardiothoracic
●Gynecologic oncology
●Urology
●Otolaryngology (head and neck)

Robotic Surgery is required for heart replacement, brain surgery, cancer, etc. The surgery process can cost anywhere between Rs 1.5 lakh to Rs 11 lakh depending on the surgery type and where the surgery is being performed.

Is Robotic Surgery Covered Under Health Insurance?

Yes, robotic surgery is covered under health insurance. According to the Insurance Regulator and Development Authority of India (IRDAI), Health Regulations 2019, every health insurance company is bound to cover robotic surgeries as modern treatment with or without a sub-limit. They cover this surgery under one of their plans.

Coverage for Robotic Surgery

The coverage for a robotic surgery includes the following:

●Cost of hospitalization
●Pre and post hospitalization
●Surgery fees
●Doctor’s fees
●Nursing charges
●Intensive Care Unit (ICU) charges
●Cost of the ambulance services used to transport the patient to the hospital

Note that the insurer covers the cost of robotic surgery according to the pre-specified limit. The remaining expenses are paid by the policyholder.

Conditions Applied for Robotic Surgery Coverage

Any health insurer only covers robotic surgeries if the surgery has been advised by a qualified surgeon trained in the technique. The claim can be denied with a recommendation from a qualified surgeon. The insurer can also reject the claim if the surgeon recommending robotic surgery is not trained in the technique required to perform the surgery.

Conclusion

Before you sign on the dotted lines, it is important to go through the policy document and be aware of the few fine prints. For instance, your claim approval will depend on the ailment for which the surgery is being carried out. If knee replacement surgery is carried out for degenerative conditions like osteoarthritis, then there will be a waiting period for the coverage in a health insurance policy.

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