Is Cashless Treatment Available for Fibroid Surgery in Bangalore?

Dear Sakshi Rana ji,

Yes, you able to get cashless treatment for uterine fibroid surgery in Bangalore through Ayushman Bharat (PM-JAY / AB-ArK) or private health insurance. However, coverage depends on your eligibility, the type of surgery advised, the hospital's network status and approval from the scheme or insurance company.

Fibroid surgery may include myomectomy (removal of fibroids while keeping the uterus) or hysterectomy (removal of the uterus). Your gynaecologist will recommend the suitable treatment based on your age, symptoms, fibroid size and future pregnancy plans.

Cashless treatment under Ayushman Bharat (PM-JAY / AB-ArK)

Yes, fibroid surgery is covered under Ayushman Bharat, including Karnataka's AB-ArK scheme, if you are eligible and the required procedure is included in the approved package at an empanelled hospital in Bangalore.

• Medical need: The doctor should recommend surgery based on your medical condition, such as heavy bleeding, severe pain or other complications. Small fibroids that do not require surgery may not qualify for a hospital treatment package.
• Waiting period: PM-JAY does not have the usual waiting period found in private health insurance. However, you must first meet the scheme's eligibility requirements and have the treatment approved.
• Hospital requirement: You must visit a government hospital or a private hospital that is actively empanelled under the applicable scheme for the required treatment.
• Cashless approval: The hospital's Ayushman Mitra desk must verify your eligibility and confirm that the exact surgery is covered under an available package.

Cashless treatment under private or corporate health insurance

Fibroid surgery is be covered under private health insurance policies, such as Star Health, Care Health, HDFC ERGO or Niva Bupa, depending on your policy terms.

• Waiting period: Personal health insurance policies may have a waiting period for specific illnesses or pre-existing conditions. The exact period depends on your policy.
• Pre-existing fibroids: If fibroids were diagnosed before you purchased the policy, the pre-existing disease waiting period may apply.
• Corporate insurance: Employer-provided policies may have different waiting-period rules. Day-one coverage is possible only if the policy specifically allows it.
• Network hospital: For cashless treatment, the hospital should be in your insurer's network and the insurer must approve the cashless request.
• Policy limits: Room-rent limits, co-payment, exclusions and non-medical expenses may affect the amount you need to pay.

Steps to Get Cashless Fibroid Surgery Under Ayushman Bharat (PM-JAY / AB-ArK)

1. Check your eligibility: First, check whether your name is included in the Ayushman Bharat PM-JAY or Karnataka AB-ArK beneficiary list. You can check through the official Ayushman beneficiary portal.
2. Open the hospital search portal: Visit the official PM-JAY hospital search portal.
3. Select your state: Choose Karnataka from the State option.
4. Select your district: Choose Bengaluru Urban or the district where you want treatment.
5. View the hospital list: Check the list of PM-JAY empanelled hospitals available in that district.
6. Select hospital type: Choose Government or Private, as required.
7. Select the speciality: Choose Gynaecology, if the speciality option is available.
8. Enter hospital details: Enter the exact hospital name if you have a preferred hospital.
9. Complete the search: Enter the captcha, if shown, and click on Search.
10. Confirm surgery coverage: Contact the hospital's Ayushman Mitra desk. Ask whether the hospital is currently empanelled and whether your advised fibroid surgery (myomectomy or hysterectomy) is covered under an approved package.

Documents Required for Ayushman Bharat

• Ayushman Bharat card or applicable AB-ArK card.
• Aadhaar card or another valid government ID.
• Registered mobile number, if required.
• Doctor's prescription and surgery advice.
• Ultrasound report showing the uterine fibroids.
• Other medical reports and previous treatment records, if available.
• Previous discharge summaries, if applicable.

Steps to Get Cashless Fibroid Surgery Under Private or Corporate Health Insurance

1. Check your health insurance policy and confirm whether fibroid surgery is covered.
2. Check whether a waiting period applies, especially if fibroids were diagnosed before purchasing the policy.
3. Find a hospital in your insurance company's network in Bangalore.
4. Consult the gynaecologist and obtain the recommended surgery advice and medical reports.
5. Contact the hospital's insurance or TPA desk and inform them that you want cashless treatment.
6. Submit your health insurance card, policy details, identity proof, doctor's advice and medical reports.
7. Complete the cashless pre-authorisation form provided by the hospital.
8. The hospital will send the pre-authorisation request and supporting documents to your insurance company or TPA.
9. Wait for the insurer's decision. Confirm the approved amount and any expenses you may need to pay yourself.
10. Proceed with planned admission after the cashless approval is received. Keep the approval and claim documents for your records.

Documents Required for Private or Corporate Insurance

• Health insurance card or e-card.
• Policy number and policy details.
• Aadhaar card or another valid identity proof.
• Doctor's prescription and surgery advice.
• Ultrasound and other relevant medical reports.
• Previous treatment records, if available.
• Cashless pre-authorisation form.
• Employee details, if using corporate health insurance.

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