Even though robotic surgery is still very young, the demand for the same has been rising. For minimally invasive surgery, the surgeon employs a robotic surgical system because it promotes quicker recovery. It is typically used for procedures requiring greater precision, such as removing tissue around the brain or significant blood veins, surgeries to replace the heart and joints, cancer affecting important organs, and brain surgery, among others.
The good news is that these cutting-edge treatments are covered under health insurance. According to the 2019 Health Regulations from the Insurance Regulator and Development Authority of India (IRDAI), insurers must cover robotic surgeries as an advanced medical procedure, with or without a sub-limit.
What is Robotic Surgery?
Robotic surgery, commonly referred to as robot-assisted surgery, allows doctors to perform various complex procedures with more precision, adaptability, and control than is possible using conventional techniques. Minimally invasive surgery, which involves procedures done through small incisions, is usually linked to robotic surgery. Occasionally, it may also be used during different kinds of open surgery. The most popular clinical robotic surgical system has an arm for the camera and mechanical arms with surgical instruments fastened to them. From a computer console located close to the operating table, the surgeon operates the arms.
What are the Benefits of Opting for Robotic Surgery?
- Minimally invasive surgery
- Lesser complications, like surgery site infections
- Less bleeding and discomfort
- Shorter hospital stay and faster healing
- Relatively smaller scars that are harder to see
When is Robotic Surgery Recommended and How Expensive are They?
Robotic surgery is typically required for disorders including cancer of the vital organs, brain surgery, and heart replacement surgery, among others. Robotic surgery is, nevertheless, a costly treatment in India. It typically costs somewhere between INR 1 and INR 10 lakh, depending on the procedure and the location of the operation.
The price of cardiothoracic robotic surgery is more than that of an abdominal robotic surgery, for instance. Similar to other medical procedures, robotic surgery is more expensive in major cities than in tier 2 cities. Therefore, most people in India find it challenging to afford robotic surgery.
Is Robotic Surgery Covered Under Health Insurance?
Yes, the IRDAI has made it compulsory for health insurance companies in 2019 to provide coverage against robotic surgeries. As a result, practically all insurers cover robotic surgery costs as part of their top health insurance policies.
Health insurance covers these expenses related to robotic surgery
- Hospitalization charges
- Surgeon/doctor’s fee
- Expenses incurred on nursing staff
- Expenses incurred in ICU
- Pre and Post hospitalization expenditure.
But Does Health Insurance Coverage for Robotic Surgery Have to Meet
On the Advice of the Surgeon
The insurer will only pay for a robotic surgery if an experienced surgeon advises it. The insurer will not cover surgeries without a qualified surgeon’s recommendation. Also crucial is that the surgeon who makes the robotic surgery recommendation is a skilled practitioner of the procedure. Insurers also request this, and if it is not provided, the health insurance claim may be denied.
Sub-limits Apply to Coverage
It's important to keep in mind that your health insurance policy's sub-limits apply to the coverage for robotic surgeries. As a result, the insurer's permitted coverage would be subject to a predetermined limit. The insured person is responsible for paying the remaining expenses. So, if your policy's total amount insured is 10 lakh, the sub-limit for robotic surgery is 1% of the whole amount insured. In that situation, the policyholder will only be eligible for reimbursement of INR 1 lakh for robotic surgery.
What is the Robotic Surgery Waiting Period Under Health Insurance?
Health insurance companies impose a waiting period before providing coverage for robotic surgery to customers who want to file a claim. Therefore, you cannot anticipate that insurance providers will permit you to submit claims for robotic surgeries on the day you get health insurance. As a result, you must wait for a predetermined period, known as the policy's "waiting period," before you can begin receiving coverage for robotic surgery. The waiting period can range from 1-3 years. However, some insurers may start covering the same after an initial 30-day waiting period, provided you did not have the disease that warranted robotic surgery. In the case of the opposite, insurers will place a waiting period of up to four years.
Conclusion
Nowadays, patients favour these surgeries because they are precise and least intrusive. The procedures performed with robotic technology are thought to be superior, especially complicated surgeries. These, however, are pricy operations that can only be carried out by qualified specialists. It is crucial to compare policies based on coverage, sub-limits, co-pay, exclusions, etc., before purchasing an insurance policy. This way, you could grab the policy that covers robotic surgery the best way.
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