Will Your Health Insurance Cover Deep Brain Stimulation Surgery?

Will Your Health Insurance Cover Deep Brain Stimulation Surgery?

Most health insurance companies offer packages that cover deep brain stimulation surgeries. Some popular health insurance companies in the public sector include The New India Assurance Co. Ltd, United India Insurance Company, National Insurance Co. Ltd., and Oriental Insurance. 

There are some private health insurance companies like Bajaj Allianz, Aditya Birla, Kotak Mahindra, Care Health, Star Health, Reliance Health, etc., that offer packages to cover brain surgeries. 

What Is The Process For Claiming Insurance At Jaslok Hospital Under Dr. Paresh Doshi?

There are two ways to claim insurance: reimbursement claim and cashless claim. In a reimbursement claim, the patient first settles all the hospital bills and then claims for insurance. He has to fill out a reimbursement form and then present it along with all the required bills, prescriptions, and other documents within 7 days of discharge. The settlement of the claim will depend solely on the insurance company. 

In the cashless claim, however, the patient can know before the surgery if he can avail insurance money or not. The normal process for a cashless claim starts 7-10 days before the date of admission. 

In this process, you first fill out a cashless request form at the hospital. Then, you inform your insurance company regarding the treatment and surgery with the cashless form from the hospital, consultation note from the doctor (if any), patient’s policy ID, policy document, and their Aadhaar and PAN card. The company may ask for more documents. 

After submitting all the documents, if the insurance company raises any medical query, the hospital will clear the doubts and resolve all the problems to their satisfaction. All the required medical details will be presented to the insurance company on behalf of the doctor to begin the insurance process. 

However, if there are any policy-related queries, such as about the previous year’s policies, or the last 5 year’s policy, the patient will have to clear that.  

After all the queries are resolved, the insurance company will grant an initial approval of the claim, depending on the amount insured in the insurance policy. For example, if the policy is of Rs. 10,00,000, you might get an initial approval of Rs. 2,00,000 – 4,00,0000. 

However, this initial amount may vary after discharge. In the final approval, the claimed amount can be more or less than the proposed amount. The insurance company after analyzing the hospital bills may increase the claimed amount to even Rs. 5,00,000 or reduce it to as low as Rs. 1,00,000. 

But you must remember that the total insurance amount is usually never sanctioned. For example, if the policy amount is Rs. 5,00,000, the insurance company may be willing to provide as much as Rs. 4,50,000 but never the whole amount, as they also have reductions to apply. 

Know Your Insurance

Although most insurance companies provide coverage for brain surgeries, you may or may not be able to avail of that if you did not pay attention while taking the insurance. 

You must look at all the terms and conditions of the insurance and see all the diseases that are covered under your insurance policy. For example, ask if your insurance policy is covering pre-existing diseases, genetic disorders, comorbidities, etc. 

You don’t know your future, so try to cover as many diseases as you can. Otherwise, because of these loopholes, your insurance may get rejected.

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