Benefits of Choosing Pristyn Care Treatment with Insurance
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LASIK eye surgery is covered by health insurance under specific circumstances. Severe refractive errors can significantly compromise the quality of life of the patients. Thus, most health insurance providers offer ample coverage for LASIK and other types of refractive surgery.
LASIK eye surgery is covered by health insurance under specific circumstances. Severe refractive errors can significantly compromise the quality of life of the ... Read More
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Benefits of Choosing Pristyn Care Treatment with Insurance
Until recently, LASIK surgery was considered an elective procedure under all circumstances, hence, insurance policies didn’t cover the cost. Fortunately, IRDAI (Insurance Regulatory and Development Authority of India) updated the guidelines for medical coverage exclusions.
The major exclusion in regards to refractive surgeries is listed under “Exclusion 15,” which states the treatment for refractive errors should be excluded if the patient’s eye power is less than 7.5 diopters. Furthermore, LASIK surgery is covered by health insurance plans under the following conditions-
In case a patient doesn’t meet these criteria and still wishes to undergo LASIK eye surgery, he/she will have to bear all the expenses incurred personally.
• Disease name
Myopia
• Surgery name
Lasik Eye Surgery
• Duration
1 Hours
• Treated by
Ophthalmologist
Ophthalmologist/ Eye Surgeon
Ophthalmologist/ Eye Surgeon
Ophthalmologist/ Eye Surgeon
Here is a breakdown of the various aspects of LASIK surgery that are covered by health insurance-
The purpose of health insurance policies was to improve their surgical experience and relieve them from the worries of expenses. However, there are some exclusions in all plans due to which the patients might have to bear some expenses on their own.
Generally, all types of refractive surgery are covered by insurance, only the amount that can be claimed for the respective technique will differ. The most popular types of LASIK surgery are given below-
Some people believe that if they choose the latest technique, the health insurance company will deny their claim entirely. However, that is not the case. The technique is chosen for a patient due to some specific medical concerns. For instance, PRK is the preferred treatment if the patient has a higher risk of developing dry eye syndrome or some other type of corneal disease. Thus, medical aspects of the technique are considered while determining the most suitable method to correct refractive errors. Thus, the patient can get coverage for all techniques. The only difference would be the amount of limit that can be claimed for each procedure.
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Here we are listing some companies that provide ample coverage for LASIK surgery in India.
Company Name | LASIK Surgery Coverage Eligibility Criteria | Network Hospitals |
Star Health Insurance | Covered if power is 7.5 D or more | 6500+ |
Manipal Cigna Health Insurance | Covered if power is 7.5 D or more | 6000+ |
Aditya Birla Health Insurance | Covered if power is 7.5 D or more | 5700+ |
Care Health Insurance | Covered if power is 7.5 D or more | 11000+ |
Bajaj Allianz Health Insurance | Covered if power is 7.5 D or more | 6500+ |
In all plans offered by these health insurance providers, LASIK surgery is now covered as long as the patient meets the eligibility criteria.
There are two methods to claim an insurance policy for LASIK surgery- a Cashless claim and a Reimbursement claim. The claim process for each method varies slightly.
A cashless claim allows the patient to pay the hospital bill upfront. In this type of claim, the insurance company pays directly to the hospital authorities with minimal involvement of the patient. However, there is a prerequisite to get a cashless claim, i.e., the patient is obliged to choose a network hospital for LASIK surgery.
The steps to get a cashless claim are explained below-
Meanwhile, the insurance company will coordinate with the hospital authorities (TPA or third-party administrator) to validate the documents. The patient is informed about the claim approval through an email and/or message stating the amount of coverage.
Note– If the approved claim amount is less than requested, the patient can always submit the claim request again to ask for more coverage.
A reimbursement claim is the compensation paid by the health insurance provider to the patient for the treatment expenses that are already paid. In this process, the patient himself/herself pays the hospital bills and asks the insurance company for compensation later. It doesn’t require the patient to choose a network hospital.
The claim process involves the following steps-
The patient is also notified through a message or email regarding the claim approval or denial. One thing that should be kept in mind is that a patient can only file a reimbursement claim for a particular treatment for a limited period. In most cases, the duration is 30 days after surgery.
Being one of the leading healthcare providers in India, Pristyn Care provides comprehensive care and assistance to patients throughout the treatment journey. We accept all health insurance policies for LASIK surgery and also accept other modes of payment which are convenient for the patients.
Our care coordinators assist the patients with the insurance paperwork, claim request, approval process, and payment confirmation. This allows the patients to focus on their health instead of worrying about the payment. Besides the assistance with insurance claims, we also provide other services that reduce the expenses of LASIK surgery for the patients-
Whether the patient has insurance or not, he/she can get optimal care at Pristyn Care and undergo LASIK eye surgery at the best prices.
A basic health insurance plan may provide coverage for LASIK eye surgery, but it depends on the specific terms and conditions of the plan. Here’s how a basic health insurance plan can potentially help with LASIK surgery:
It’s important to note that the extent of coverage for LASIK eye surgery can vary greatly between different insurance plans. Some plans may have specific exclusions or limitations for elective procedures like LASIK. It’s crucial to review the terms and conditions of your specific health insurance plan or contact your insurance provider directly to understand the coverage, limitations, and associated costs for LASIK eye surgery under your insurance coverage plan.
Factors to Consider | Description |
---|---|
Stable vision | The prescription for glasses or contact lenses should have remained consistent for 1-2 years |
Age | Typically suitable for individuals who are at least 18 years old with a stable eye prescription |
Eye Health | Ensure that your eyes are healthy and free from any underlying eye conditions or diseases |
Lifestyle factors | Consider your activities and commitments, especially if they involve a high risk of eye injury |
Recovery and downtime | Account for the short recovery period and any upcoming commitments or events during that time |
It’s important to consult with an ophthalmologist or refractive surgeon for personalized advice based on your specific circumstances. They will evaluate your eye health, the stability of your prescription, and your individual lifestyle to determine the optimal timing for LASIK eye surgery.
Inclusions under a health insurance policy that offers coverage for LASIK eye surgery can vary depending on the specific policy and insurance provider. Here are some common inclusions that may be covered:
It’s important to carefully review the terms and conditions of your specific health insurance policy to understand the exact inclusions, coverage limits, and any associated requirements for LASIK eye surgery. Different policies may have different coverage levels and criteria, so it’s best to contact your insurance provider directly or refer to your policy documents for accurate and up-to-date information.
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