Varicocele Surgery Covered Under Health Insurance - 100% Cashless

Expenses of Varicocele Surgery Covered by Insurance

The expenses covered by health insurance usually depend on the policy purchased. In general, the following expenses are likely to get covered by insurance-

• The doctor’s consultation and operating fee
• The anesthesia and anesthetist’s fee
• Diagnostic tests and evaluations done during hospitalization
• Hospital admission and discharge fee
• OT and ICU charges
• Room rent (single, double, or sharing) on a daily basis
• Nursing fee and medicines given to the patient during the hospital stay
• Medical consumables, such as syringes, sutures, staples, catheters, gloves, masks, adhesives, dressing, etc.
• Post-surgery follow-up consultations

The insurance policy can be further customized through add-on coverage features for which the patient will have to pay higher premiums.

How to Claim Health Insurance for Varicocele Treatment?

There are two different ways to get a health insurance claim for surgical treatment. The patient can choose to get either- cashless or reimbursement claim. The cashless claim can only be made at the network hospital of the insurance company. If patients seek treatment at a non-network hospital, they can only get a reimbursement claim.

The steps to get a cashless claim for varicocele treatment are explained below-

• Choose a hospital from the network of the insurer and inform the TPA 2-5 days prior to the surgery.
• Fill out the cashless claim form, attach the required documents, and submit the form at the TPA desk.
• The TPA team will send the form for pre-authorization along with the required documents.
• The insurance company will provide approval for the claim request after verification.
• The hospital bills are settled by the insurance company directly.

If the claim is denied due to some reasons, the patient can file a reimbursement claim in the steps below-

• Contact the insurer within 48 hours of hospitalization.
• Pay the surgery cost at the hospital and get discharged as usual.
• Get the reimbursement claim from the insurance agent.
• Fill out the form and submit the required medical records and other documents.
• The insurance company will verify the documents and approve the claim according to the terms and condition of the policy.
• Once the claim is approved, the claim amount will be credited to the policyholder’s bank account or a cheque will be issued in the policyholder’s name.

One thing to keep in mind is that reimbursement claim can only be raised within 30 days of discharge. If delayed, the patient might not be able to get the claim.