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Is cataract surgery covered by insurance?

Yes, cataract surgery is covered by insurance. Insurance makes it easier for patients to cover the full cost of cataract surgery. However, terms regarding coverage and amounts you can claim may vary from patient to patient. Therefore, it is important to check the policy details before purchasing insurance.

So today we will learn more about receiving cataract surgery Learn about insurance and other things patients should know about health insurance.

Why is cataract surgery covered by insurance?

a Cataract Although it progresses slowly, it is a very serious condition that can significantly impair vision. It affects the patient’s quality of life. And if left untreated for a long period of time, it can lead to blindness. Treatment is therefore medically necessary.

There is no natural cure for cataracts, so surgery is the only option. Surgery can restore vision to normal. Therefore, in order to ensure that patients do not lose their sight, insurance companies provide sufficient coverage for cataract surgery in their basic policy.

Normal, cataract surgery cost In India it ranges from Rs. 20,000 rupees about 1,50,000. Actual costs may vary from patient to patient due to factors such as doctor’s fees, diagnostic tests, hospital charges, cataract lenses and post-surgery care. hospital of their choice.

Is all cataract surgery covered by insurance?

yes. Cataract surgery is medically necessary to restore vision and protect patients from partial or complete blindness. Therefore, all procedures are included in the coverage.

Surgery is recommended by the surgeon after an accurate diagnosis. Also, the cost of various procedures varies, so insurance may or may not cover the full cost of treatment.

For example, phacoemulsification cataract surgery costs about Rs. $40,000 per eye, extracapsular cataract surgery costs around Rs. 40,000 USD 60,000 per eye, bladeless cataract surgery costs around Rs. 85,000 Rs. 1,20,000.

*Note- Bladeless surgeries include MICS (micro-incision cataract surgery) and FLACS (femtosecond laser-assisted cataract surgery).

Waiting period for cataract surgery

Most health plans have two years of coverage for cataract surgery. This means that patients will have to wait at least two years before they can file a claim. This clause is added to the policy to prevent policyholders from purchasing the policy solely to cover the cost of cataract surgery.

In corporate insurance contracts, the policy may not have a waiting period clause. It is best to consult with your health care provider for a clear understanding of the terms of use.

Claim limit for cataract surgery

Insurance companies also set limits on the amount a policyholder for cataract surgery can claim. Any additional costs incurred during or after treatment beyond certain sub-limits must be borne by the patient.

The good news is that billing limits are usually not the same from policy to policy. Make sure you have the full amount available.

Cataract surgery costs covered by health insurance

The breakdown of costs typically covered by health insurance is as follows:

  • Hospitalization fees include hospitalization fees, bed fees, room fees, medical consumables, ICU fees, OT fees, nursing fees, etc.
  • Hospital costs before and after surgery, including pre-surgery consultation and follow-up.
  • Ambulance costs are also covered by the policy, usually up to Rs. 2,000.
  • Cost of medication given to the patient during their stay.
  • Surgeon costs, anesthesiologist costs, and anesthesia costs.
  • The cost of a standard intraocular lens, i.e. a monofocal lens.
  • Second opinion from another doctor.

Insurance is provided to help people get the best possible care without worrying about the cost. However, there are some exclusions in insurance plans that people are not usually aware of.

Expenses not covered by insurance

Please note that the following costs are not covered by health insurance under any circumstances.

  • Cost of premium intraocular lens (cataract lens)
  • prescription glasses
  • eye drops and medicine

You are responsible for these costs.

Popular health insurance that covers cataract surgery

Here we have listed some of the popular plans offered by various insurance companies in India.You can take a look at them and choose the best plan for yourself.

Insurance company plan waiting period Allowable Billing Limit
ICICI Lombard complete health insurance 2 years up to Rs. 20,000 per eye
Long-term care insurance Care freedom (elderly) 2 years up to Rs. 25,000 (depending on the insurance amount selected)
star health insurance Senior Citizen Red Carpet Policy 2 years up to Rs. 25,000 (depending on the insurance amount selected)
Toyo Insurance happy family floater 2 years No sublimit
SBI General Health insurance 2 years Up to 15% of the insured amount is guaranteed with a cap of Rs. 25,000 per eye
Apollo Munich Health Insurance optima senior 2 years No sublimit
Bajaj Allianz health guard 2 years Up to 10% of insurance amount up to Rs. 35,000

There are many other reputable insurance companies such as Niva Bupa, HDFC Ergo, Manipal Cigna, Aditya Birla, Apollo Munich, Tata AIG, etc., which offer a variety of health insurance plans depending on the patient’s needs. Choose the plan that works best for you.

How do I claim for cataract surgery?

Thanks to modern technology, cataract surgery is performed on a daycare basis. Therefore, insurance covers treatment under day care procedures. This means the patient does not have to be in her 24-hour hospital to get billed.

Insurance companies offer two options for claiming cataract surgery: cashless and reimbursement, and the process for each is slightly different.

cashless billing

In order to receive a cashless claim from an insurance company, you must choose a network hospital for cataract surgery.

step 1- Please notify your insurance company at least 3 days before the procedure and complete the cashless form. The hospital’s TPA team coordinates with insurance companies to obtain claims in advance.

Step 2- The insurance company will send you an email and/or message to confirm that your claim request has been approved.

If you are billed less than the requested amount, you can always submit a second claim request for additional compensation for the procedure.

recourse

step 1- Choose a hospital and schedule your surgery. Tell your insurance company that you will have surgery. You can also notify your insurance company within two days of your admission.

Note- We recommend notifying the company early to avoid problems with the paperwork and billing process.

Step 2- Get a refund form online or from your insurance agent. Complete the form and submit all documentation, including discharge summary, pre- and post-surgery evaluations, and other bills.

Step 3- As soon as the documents are submitted, the insurance company will verify them and refund the full amount of the surgery in the shortest possible time.

You will also be notified if your application is rejected. It should also be noted that there are certain time periods during which patients can claim reimbursement. This period is usually 30 days after surgery. This period may vary depending on your insurance plan.

Contact Pristine Care to Get Cataract Surgery

If you have been diagnosed with cataracts and need surgery, you can always contact Pristyn Care. We provide the best service for cataract patients. It also helps patients maximize their claims for treatment.

Over 80% of Indians are uninsured and therefore do not benefit from health insurance. As such, Pristyn Care provides affordable healthcare and services that reduce the cost of care for patients. Services include −

  • Free initial consultation
  • Free transportation service on the day of surgery
  • Multiple follow-up consultations at no extra charge
  • Flexible payment options including cash, credit cards and health insurance
  • Free EMI service to split treatment costs into easy installments

Call us for more information on our services.

https://www.pristyncare.com/blog/is-cataract-surgery-covered-by-insurance/ Is cataract surgery covered by insurance?

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