Nagpur: As mucormycocia also leads to surgeries to remove facial bones or eyes to save patients’ lives, one wonders if subsequent plastic surgeries to treat disfigurement would be covered by health insurers.
The surgeries are expensive with bills ranging from 5 to 6 lakh rupees in some cases, doctors said.
In the normal course, insurance companies do not pay for plastic surgeries because they are considered cosmetic treatments and are not necessary to save a patient’s life or maintain the functionality of any part of the body.
Reconstructive surgeries would follow at least three months after the primary procedure due to the mucormycosis. With the surge in cases of mucormycosis for almost a month, patients still have to face the issue of insurance claim.
When TOI spoke to insurance companies and associated professionals, the response was mixed.
In what may be good news for mucus patients, a professional with links to some private companies said the expenses would be covered.
Manoj Aya of M / s GNTL Financial Services, an insurance consulting firm, said it had been confirmed by the private company he was dealing with that even plastic surgery needed after mucormycosis would be covered.
“I consulted with a team of doctors reviewing the allegations. They said it was considered a complication related to Covid due to which reconstructive plastic surgeries would be paid for, ”Aya said.
Dr Darshan Rewanwar, a plastic surgeon in the city, said the surgeries should be covered by insurance companies. Surgeries to remove body parts should be performed to prevent the spread of infection. This is followed by operations to maintain the functionality of the body part. In the case of the eyes, it is necessary to maintain symmetry, he said.
However, an official at a private hospital who returned after speaking to an insurance company said plastic surgeries would likely not be covered. This is because it is an external treatment and not necessary to cure the disease as such.
Officials from two other companies said they had yet to present such cases to regional offices. It is likely that in a particular case the plastic surgery costs of patients with mucormycocis can be reimbursed. “There haven’t been any clear instructions yet,” they said.
“The general rule is that we assess whether a particular surgical intervention is necessary for the patient to continue with his daily work. While this can happen even without plastic surgery, the costs cannot be reimbursed or covered by cashless systems, ”an official said.