Is Cashless Treatment Available for Nasal Polyp Surgery in Kolkata?

Dear Prerna Tikoo ji,

Yes, cashless treatment for nasal polyp surgery is available in Kolkata through private health insurance or an eligible government health scheme. Nasal polyps are soft growths inside the nose that can cause a blocked nose, difficulty breathing, reduced sense of smell and repeated sinus infections. Depending on your condition, an ENT (Ear, Nose and Throat) specialist recommend nasal polyp removal or Functional Endoscopic Sinus Surgery (FESS).

• Ayushman Bharat PM-JAY: Eligible beneficiaries can receive cashless treatment for covered hospital procedures at participating hospitals. However, do not assume that every hospital in Kolkata accepts PM-JAY.
• Swasthya Sathi: Eligible beneficiaries in West Bengal able to receive cashless treatment at hospitals participating in the state scheme. Check the hospital's current participation and whether nasal polyp surgery is covered.

How to check Ayushman empanelled hospital?

1. Open the official PM-JAY hospital search portal.
2. Select West Bengal as your state.
3. Select Kolkata or the relevant district.
4. First check the overall list of empanelled hospitals in your district.
5. Select Government or Private under hospital type.
6. Choose ENT or the relevant speciality, if available.
7. Enter the name of the hospital you want to check.
8. Enter the captcha if shown and click Search.
9. Contact the hospital's scheme help desk to confirm active empanelment and coverage for nasal polyp surgery.

Can private health insurance cover nasal polyp surgery?

Yes, many health insurance policies cover medically necessary nasal polyp surgery, subject to the policy terms. You must check the following before admission:

• Network hospital: The hospital must be part of your insurer's network for cashless treatment.
• Waiting period: If you already had nasal polyps or sinus problems before buying the policy, a pre-existing disease waiting period may apply.
• Policy limits: Check your sum insured, co-payment, room-rent limits and other deductions.
• Pre-authorisation: The hospital usually sends a cashless approval request to the insurer before planned surgery.

How can you get cashless approval through private insurance?

1. Consult an ENT specialist and obtain advice for the recommended treatment.
2. Choose a hospital that is in your insurance company's network.
3. Visit the hospital's insurance or TPA desk with your policy details and medical reports.
4. Submit the required documents for pre-authorisation.
5. Confirm the approval amount and any expenses you may need to pay yourself before proceeding with planned surgery.

What documents are required?

• Ayushman Card or Swasthya Sathi card, if applicable.
• Aadhaar card or another accepted identity document.
• Private health insurance card and policy details, if applicable.
• ENT specialist's prescription and treatment advice.
• Nasal endoscopy report and CT scan of the sinuses, if performed.
• Previous prescriptions, medical reports and treatment records.
• Any additional documents requested by the hospital or scheme help desk.

Under a government scheme, eligible treatment is cashless within the approved package and scheme rules. Under private insurance, you may have to pay for expenses not covered by your policy, applicable co-payment, deductibles or costs above policy limits. Always ask the hospital for a clear estimate and confirm what is covered before admission.

If you have an eligible Ayushman or Swasthya Sathi card, first check whether a participating hospital covers the required procedure. If you have private health insurance, ask your insurer for its current network hospital list and confirm the waiting period and cashless approval requirements.

To help you find the right option, please share whether you have an Ayushman Card, a Swasthya Sathi card or private health insurance. Also mention your preferred area in Kolkata, such as Salt Lake, EM Bypass or South Kolkata.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth