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Will I get reimbursement for the cost of tonsillectomy?

Q: I have been suffering from fever, cough and throat pain from the past one week. On detailed examination by a doctor, it was diagnosed as chronic tonsillitis. I have been advised to undergo tonsillectomy with turbinoplasty to avoid recurrence of the problems in future. The surgery will be done using KTP-532 laser which is 100% safe, with no bleeding and the surgery cost is around sixty five thousand rupees. The operation cost can be reduced if I seek traditional dissection method elsewhere, which is not risk-free and bound to have complications, especially in my case. I have a mediclaim policy of New India Assurance Company, but their policy prospectus doesn't explicitly state if the above treatment will be covered under the scope of their insurance. Should I seek a written authorisation from the insurance company to go ahead with the laser method before the surgery or should I seek their advice regarding an alternative treatment? Will the insurance company reimburse the treatment cost for the above ailment irrespective of the technique used?

A:Under Mediclaim, irrespective of the technique used, you will be reimbursed the full cost of the procedure provided it is relevant to the disease and the policy does not have any cap on the cost of a single procedure. If you are having the procedure carried out at a network hospital of your TPA, then the authorisation for the procedure shall be taken by the hospital/nursing home itself. This disease should not have existed at the time of taking the policy cover for the first time especially so if you have taken a retail cover (as compared to a group health insurance where at times pre existing diseases can be covered). Given that you have a chronic condition, this may be excluded in case it was a pre existing disease.


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