Is Cataract Surgery Covered by Insurance?

Cataract surgery may be expensive for people with limited financial resources. Hence, in such cases, to get cataract surgery done, the patient or the patient's family may go for various payment options, such as cataract surgery covered by insurance. There are several financing options available for cataract surgery. Some of the financial options available for cataract surgery include the following, 

Cataract surgery covered by health insurance

1. Health insurance can provide financial assistance during medical emergencies, including coverage for cataract surgery in India.
2. Medical insurance can cover hospitalisation costs, provide tax benefits, offer affordable premiums, and allow cashless treatment at partner hospitals.
3. Additionally, medical insurance can offer access to second opinions from renowned doctors, and individuals can compare and find the best health insurance plans online.

Cataract surgery by EMI 

1. EMI is a fixed monthly payment someone pays to the person or organisation they borrowed money from. The payment includes both the money borrowed (principal) and the interest charged.
2. The borrower can repay the entire loan by paying the same amount every month for a few years.
3. EMI options for cataract surgery can make this procedure more accessible and affordable for patients who cannot afford to pay for the surgery upfront.
4. Patients can choose a repayment plan that fits their budget and financial situation, making it easier to manage the cost of the procedure over time.
5. Additionally, EMI options may be interest-free or come with low-interest rates, reducing the overall cost of the procedure.

Cataract surgery on medical loan

1. A medical loan is a type of personal loan available to people who need money to pay for medical emergencies.
2. This loan can be used to cover various expenses, including hospital bills, surgery expenses, prescription costs, chemotherapy, and any other medical-related expenses. A medical loan can be obtained for cataract surgery. 

Regarding cataract surgery covered by insurance, several factors can affect the extent and level of coverage a patient receives. These factors can include:

1. Age
   1. Age is crucial in determining health insurance premiums. Younger individuals pay lower premiums as they are less likely to require medical coverage.
   2. As one age, the likelihood of hospitalisation and medical expenses increases, resulting in higher premiums. Some insurance providers have an age limit for purchasing new policies as assessing risk factors and medical expenses with advancing age becomes difficult.
   3. Hence age is an essential factor affecting cataract surgery covered by insurance. 
2. Medical History
   1. Individuals with pre-existing medical conditions such as high blood pressure or diabetes may experience long-term effects on their health, which can result in higher medical bills and hospital charges.
   2. The severity of their condition, as evaluated by a doctor, will determine the amount of the premium they must pay for their health insurance.
3. The insured sum
   1. The amount of money chosen for the healt her premium, but it will provide more coverage for medical expenses. Choosing an SI that suits the patient's needs and budget is essential.
4. Occupation
   1. Occupation is a significant factor in determining the health condition and the cost of the health insurance premium.
   2. For example, suppose a person has a high-stress job or works in a hazardous environment.
   3. In that case, they may be charged a higher premium due to the increased likelihood of developing significant medical issues. 
5. Lifestyle
   1. Another potential factor that may affect cataract surgery health insurance coverage is the patient's lifestyle.
   2. Habits such as smoking and consuming tobacco may affect the insurance premium, as these activities may increase the likelihood of developing cancer and other severe conditions. 

Several medical insurance companies provide coverage for cataract surgery to ease the financial burden on patients. Some of these include: 

When it comes to medical procedures, particularly those that are costly, it's essential to have medical insurance coverage. One way to ensure you can access quality healthcare without worrying about the financial burden is by choosing hospitals empanelled under medical insurance companies. This section will discuss some of the top hospitals empanelled under medical insurance companies, particularly for procedures such as cataract surgery. 

1. Accura Eye Care, Delhi
2. Aravind Eye Hospital, Madhurai
3. Drishti Netralaya, Mumbai
4. Aaradhya Netralaya, Pune 
5. Nelivigi Eye Hospital, Bangalore
6. ECHS Empaneled Network Hospitals 

Ex-Servicemen Contributary Health Scheme (ECHS) is a type of healthcare scheme that is offered to retired armed forces personnel and their family members. The list of some of the ECHS hospitals includes the following, 

1. Ruby Eye Hospital, Bhubaneshwar
2. Jagdamba Eye Hospital, Alwar
3. Nandadeep Eye Hospital, Sangli
4. Birla Eye Hospital, Nashik
5. J V R Eye Hospital, Kangra

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a national health insurance scheme launched by the Indian government to provide financial protection to poor and vulnerable families for secondary and tertiary care hospitalisation. The scheme covers over 10 crore poor and vulnerable families in India, making it one of the world's largest health protection schemes. One of the medical procedures covered under this scheme is cataract surgery.

The cataract surgery coverage includes the following:

1. Pre-operative investigations: The scheme covers the cost of pre-operative investigations such as blood tests, urine tests, and ECG.
2. Surgical procedure: The scheme covers the cost of cataract surgery, including the surgeon's fee, anaesthetist's fee, and charges for the operation theatre.
3. Post-operative care: The scheme covers the cost of post-operative care, including medications, dressings, and follow-up consultations.

The scheme covers both phacoemulsification and manual small incision cataract surgery (MSICS). The beneficiaries can choose either of the procedures, depending on their preferences and the doctor's recommendation.

1. Under the Ayushman Bharat scheme, patients can avail of cataract surgery at empanelled hospitals free of cost. The scheme covers the cost of pre-operative investigations, surgery, post-operative care, and medicine for 10 days after the surgery.
2. To avail of the benefits of the Ayushman Bharat scheme, patients need to be registered under the scheme. The registration process is simple and can be done through the Ayushman Bharat website, by calling the Ayushman Bharat helpline number, or by visiting a nearby Ayushman Bharat center.
3. However, it is important to note that not all hospitals are empanelled under the Ayushman Bharat scheme. Patients need to visit an empanelled hospital to avail of the benefits of the scheme. They can check the list of empanelled hospitals on the Ayushman Bharat website or by calling the Ayushman Bharat helpline number.

To get the services that are covered by the health insurance policy, a health insurance claim is to be submitted to the insurance company. There are two methods available for claiming health insurance. These include the following, 

1. Cashless claim
2. Reimbursement claim

Cashless Claim Process

1. To get a cashless claim for cataract surgery; the patient must enrol in a network hospital, after which the health insurer will take care of the bill. 
2. The patient must get approval for the treatment in advance from the insurer. The patient must fill out the necessary forms and share the ID proof and health e-card with the hospital. 
3. The forms are to be shared with the insurer and third-party administrator. Once done, the patient is to wait for the claim to settle. The cashless claims are to be approved by the insurer beforehand. 
4. For planned hospitalisation, the insurer must approve the claim before at least 72 hours. In case of an emergency, the claim is to be approved by the insurer within 24 hours.  

Reimbursement Claim Process

1. A reimbursement claim is a type of claim where the patient is supposed to pay the hospital bills post-treatment. Then, these bills are to be submitted to the insurer along with any other documents, such as medical documents, to get the claim approved. 
2. To get the reimbursement claim, all the bills and documents will be collected after the treatment. 
3. Then, the patient is to fill out all the necessary forms and submit the documents along with the bills to the insurer to claim the reimbursement. 

In conclusion, cataract surgery is a common procedure that can significantly improve a patient's vision and quality of life. However, the surgery cost can be a significant burden for many patients, especially those with limited financial resources. This is where medical insurance can play a critical role in providing financial assistance and making the procedure more affordable. One can consider various  financing options available for cataract surgery, such as EMI and medical loans. These options can make the procedure more accessible and affordable for patients who cannot afford to pay for the surgery upfront.

HexaHealth offers a wide range of medical services, including cataract surgery. We understand the importance of insurance coverage for our patients and strive to make the process as hassle-free as possible. Our team of highly qualified professionals is dedicated to assisting patients with their insurance claims, ensuring that they receive the coverage they are entitled to. Whether you need cataract surgery or any other medical service, choose HexaHealth for a stress-free and reliable healthcare experience.