Does Health Insurance Cover The Cost Of Surgery? | 7059


Does Health Insurance Cover The Cost Of Surgery?

As the treatment cost of healthcare and the risk of diseases in India is tremendously increasing, it has become a necessity to get secure with the best health insurance plan. But, are you looking for the answers to these questions before investing your money-

What are the diseases your health insurance will cover? Will I be able to reap the benefits of health insurance during surgery? In this article, we’ll help you to understand all about health insurance and surgery.

What Does Health Insurance Cover for Surgery?

The good news is that most health insurance plans cover surgeries, but only under certain conditions. The covered costs must be deemed medically necessary,’ which means they must be for a surgery that is either life-saving, health-improving, or intended to prevent an illness. However, surgeries performed for ‘cosmetic reasons’ are rarely covered.

For example, a rhinoplasty or a nose job, if it helps a person breathe better or reconstruct their face after an accident will be covered but not one done merely because you would like to change the way your nose looks.

How Much Coverage Does Health Insurance Provide for Surgeries?

The coverage provided by the health insurance companies for surgeries depends on several factors. You can determine the benefits provided for the surgery and check the terms and conditions of your policy by reaching out to your health insurance company. Moreover, you can contact your doctor and surgeon to find the approximate surgery cost and plan accordingly. Remember that no one can give an exact figure because there can be extra expenses depending on what the physicians find out while performing the surgery.

What are the Additional Costs of a Surgery?

There are certain aspects of surgery that go along with its general costs such as:

1. Pre-Operative and Post-Operative Tests: Bloodwork, x-rays etc. that are required to check the patient’s condition before and after the surgery.

2. OT Cost: The Operation Theatre, where the surgery will take place, will be charged separately on a per-hour basis.

3. Surgeon and Attendant’s Fee: Applied separately on the bill will be the fee of those attending to the patient during the surgery. They include the surgeons, co-surgeons and any other doctors or nurses required.

4. Medication: Such as intravenous medication, anaesthesia etc as required and prescribed by the doctor.

5. Medical Equipment: Such as a brace or crutches required by the patient after surgery.

6. Recovery Room and Inpatient Care: Depending on the situation of the patient there is a stipulated recovery time after the surgery and care that is required for the patient. These will be added to the cost of the surgery.

The coverage on these aspects will depend on your insurance policy as each plan has different coverage levels.


Surgeries demand a high-cost treatment and are covered in health insurance policies but with some terms and conditions. Mostly, claims are approved only in the cases of ‘medical necessity. However, the details of the coverage vary greatly among different policies. The best way is to reach your health insurance provider to understand and clarify all the benefits, features, terms and conditions of your plan.

Now, you can buy a health insurance plan online. With just a few clicks you can compare health insurance companies, the plans they offer, their network of cashless mediclaim hospitals and check the premium calculator. Even insurance renewal can now be done online.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.



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