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Robotic surgery for knee replacement

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30 Jul, 2023 by  tejinder sethi

I have Care medical policy from Care Insurance. My policy was ported in December 2020 from National Insurance which was in force from 2014. So all waiting period is over.

The question is, as per the policy terms and conditions Knee replacement is covered upto SI and for Robotic Surgery ithe company will indemnify the Insured Person 

up to Sum Insured for

treatment taken through advance

technology methods.

Now when I wrote to the company as to check with them as my wife is planning to undergo Robotic surgery for knee replacement in 2 to 3 months, they are saying that Robotic Surgery will not be covered for knee replacement. This is contradictory to the terms and conditions of the policy. Please advise.

Health Insurance

1 Answer

09 Aug, 2023

Hello Tejinder,

If it is explicitly mentioned in the policy document that 'treatments taken through advance technology methods will be covered up to Sum Insured', the insurer cannot refuse coverage by stating otherwise. You should contact your insurer and ask them where in the policy document have they mentioned that robotic surgery for knee replacement is not covered. If they cannot provide this information, they are obligated to cover the procedure. If they still deny coverage, you have the option of filing a complaint against them. We have written a detailed article that outlines the various channels through which you can file insurance-related complaints in India. You can check it out here:

How To File A Complaint Against An Insurance Company In India? | Beshak

Thank you!

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09 Aug, 2023
tejinder sethi
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