Cashless or Mediclaim Coverage of Hypospadias repair surgery and treatment by Insurance Companies in India
Hypospadias is a urinary birth defect in which the urinary opening is on the underside of penis rather than being at the tip of the penis. In more than 50% of patients with hypospadias, the penis is also bent downwards – this penis curvature is called chordee. Hypospadias affects 1/150 newborn boys and hence more than 1 lakh (1,00,000) kids are born in India with hypospadias every year. Worldwide the incidence of hypospadias has increased, research has postulated that this is due to increasing burden of chemicals and pollutants which act as endocrine disruptors (chemicals which block male hormone action) and have contributed to an increasing incidence of hypospadias.
Most of these kids except the ones with very minor glanular hypospadias without chordee will need hypospadias repair surgery. The hypospadias correction surgery is ideally done between 6months-18 months of age for a child born with good weight and full term. If the child is underweight or preterm or has any other major anomalies, then it may be better to wait for hypospadias repair till the child is about 3 years of age.
Is Hypospadias repair surgery covered by insurance companies or corporates for cashless treatment or re-imbursement?
Hypospadias being a penis birth defect is classified as an external birth defect which can be easily diagnosed as soon as the baby is born. Hence, if parents take an insurance policy after the baby is born, hypospadias surgery treatment costs are not covered by most of the insurance companies in India. There is a special health insurance policy which has to be taken by parents for the unborn child during the first few months of pregnancy which can cover hypospadias and other birth defects in India. In other countries such as USA, UK, Europe or Australia, most of the insurance companies do cover hypospadias birth defect under insurance benefits.
The situation is different for some of the corporate insurance group policy holders. Some big corporates and multinational companies issue very comprehensive employee friendly Mediclaim policies which cover all medical and surgical treatments for the employees and their families including birth defects. Such Mediclaim policies cover all pre-existing illnesses as well as birth defects for their employees and hence hypospadias repair procedure may be covered by the insurance company by some of these companies. If you have a corporate insurance health policy, please speak to your Human resources or employee benefits team to crosscheck with the insurance company and check if hypospadias surgery for your child would be covered or not.
If insurance does not cover the hypospadias treatment, how much does it cost for Hypospadias repair surgery?
If the insurance company is not covering the treatment, then the parents will have to pay the full charges themselves out of their own pocket. For new parents working in a job or middle-class environment this may be financially stressful. What really helps is that Hypospadias repair surgery is a planned procedure. It can be done anytime between 6 months-18 months of age, giving parents enough time to rally around and arrange everything from money to other resources. The cost of hypospadias repair surgery depends on the type of hypospadias, complexity of repair, which hospital as well as which type of room one chooses to stay in hospital. As of Nov 2023, on a ballpark figure, the total cost of hypospadias repair surgery may vary from 1,25,000 Indian rupees for a minor hypospadias surgery in Hypospadias Foundation to 2,50,000 Rupees for a complex severe hypospadias surgery in a single deluxe room. For cases which have DSD, it may be even higher as laparoscopy may be needed. Hence, it is best that they meet a hypospadias expert or a pediatric urologist early in the first 3 months of baby’s life and then learn everything about the cost of hypospadias surgery, hospital stay, pre-hypospadias surgery tests and then get mentally prepared for the actual surgery. There are some discounts offered for patients who have financial constraints.
About Hypospadias Foundation, Navi Mumbai, India
Hypospadias Foundation is an organization for caring, education and research in the field of Hypospadias. The team operates with more than 200 children and adults every year with the best results for hypospadias treatment. The Foundation operates as a part and parcel of MITR Hospital in Kharghar area of Navi Mumbai. MITR Hospital has cashless and mediclaim tie-ups with all major insurance companies and TPA’s to facilitate cashless treatment of hypospadias if the insurance policy covers it.
If you or your child has hypospadias and need to know more, please write to us at hypospadiasfoundationindia@gmail.com
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