Health Insurance for Kidney Stones

What Does Kidney Stones Treatment Cost in India?

Kidney stones are highly treatable, but treatment costs can be significantly high if not addressed early. So, depending on the size of your kidney stones and their location, treatment may include prescribed medications, ureteroscopy, laser lithotripsy, shock wave lithotripsy, or surgery to remove larger stones.

On average, kidney stone treatment costs between ₹50,000 and ₹2 lakh. On top of that, you might also have to bear the cost of diagnostic tests. An abdominal ultrasound can range from ₹1,500 to ₹2,500, an X-ray from ₹200 to ₹500 per view, and a CT scan from ₹3,000 to ₹4,500. Doctors might also recommend a CT KUB scan, which can range from ₹5,000 to ₹10,000.

Take a look at the cost breakdown of kidney stone treatment costs in India:

Note: The costs mentioned above are estimates and may vary depending on the hospital, city, and the size and location of kidney stones.

You can easily manage your expenses while getting treated for kidney stones with a comprehensive health insurance plan. These offer cashless treatment options, which reduce your out-of-pocket expenses and financial burden.

Does Health Insurance Cover Every Stage of Kidney Stones?

Yes, health insurance plans cover treatment for every stage of kidney stones. If you have small stones that can be treated with medicines, hydration, and pain relievers, OPD health insurance can cover the expenses.

However, larger stones that cause severe pain, are stuck, or require procedures such as Extracorporeal Shock Wave Lithotripsy (ESWL), Ureteroscopy (URS), or PCNL are covered by health insurance plans under in-patient hospitalisation and day care procedures.

Moreover, if kidney stones advance to life-threatening conditions such as kidney failure, which can develop as a complication of severe or untreated kidney stones and may require regular dialysis, it is covered by critical illness insurance plans.

Which Type of Health Insurance is Best for Kidney Stones?

Although regular health plans and critical illness insurance plans offer coverage for different stages of kidney stones, a health insurance plan with OPD cover is the best for comprehensive coverage. Based on the severity of your kidney stones and coverage requirements, you can find the best medical insurance for yourself.

Let us look at the table below to understand which type of health insurance is the best for kidney stones:

Note: The coverage mentioned above may vary depending on the health insurance policy you opt for.

So, if you are young and have not been diagnosed with kidney stones yet, you should go for individual or family health insurance plans. However, if you have a family history of severe kidney stones that lead to kidney failure, then you should also get a critical illness insurance plan.

What is Covered by Health Insurance for Kidney Stones?

Health insurance for kidney stones covers:

• Hospitalisation expenses including room rent, OT fees, and surgeon's fees
• Surgeries including open surgery and PCNL
• Day care procedures such as RIRS, ESWL, and URSL
• Stent management
• In-patient diagnostic tests
• Pre-hospitalisation expenses
• Post-hospitalisation expenses
• OPD charges
• Stone removal surgery
• Ambulance charges
• Hospital daily cash

Note: The exact coverage depends entirely on your health insurance policy and the severity of your kidney stones.

What is Not Covered by Health Insurance for Kidney Stones?

The following expenses are not covered by health insurance for kidney stones:

• Kidney stone treatment taken outside India
• Diagnostic expenses which are not related to kidney stone treatment
• Expenses related to any experimental or unproven treatment
• Treatment for alcohol abuse or drug abuse

Note: The exact list of exclusions varies depending on your health insurance policy for kidney stones.

Benefits of Buying Health Insurance for Kidney Stones

Buying medical insurance for kidney stones can offer you the following benefits:

1. Covers Expensive Kidney Stones Surgery Costs

   Kidney stones treatment may include advanced and minimally invasive procedures such as retrograde intrarenal surgery (RIRS) or laser lithotripsy. These can increase your medical expenses to up to ₹2 lakh. However, a health insurance policy for kidney stones provides coverage against high treatment costs and reduces the financial burden.

2. Diagnostic Tests Coverage

   Identifying, tracking, and preventing a kidney stone heavily depend on expensive imaging and lab work, such as CT KUB, stone composition analysis, and other advanced tests. This adds to the already high kidney stone treatment cost. With a health insurance plan, these costs are taken care of by your insurer, allowing you to focus on your treatment and recovery.

3. Tax Benefits under Section 80D

   The premium you pay towards your health insurance policy qualifies for a tax deduction under the old tax regime of the Income Tax Act. You can claim a deduction of up to ₹25,000 for non-senior citizens, or up to ₹50,000 if you are a senior citizen, lowering your overall tax liability.

Why Should You Buy Health Insurance for Kidney Stones Before Diagnosis?

When you buy health insurance before kidney stones are diagnosed, it helps you save money and prevent claim rejections. Here are some reasons why you should buy medical insurance plans for kidney stones before diagnosis:

1. Limited Coverage for Pre-Existing Kidney Stones

   If you have been diagnosed with kidney stones before buying your health insurance policy, it will be classified as a pre-existing condition. As a result, insurers may also offer limited coverage for the disease, impose waiting periods or deny coverage altogether. Purchasing a health insurance policy before getting diagnosed helps you secure medical coverage for kidney stones when diagnosed later and save on out-of-pocket expenses.

2. Waiting Period

   Most health insurance plans have an initial waiting period of 2 years for kidney stones, as they are classified as a specific slow-growing illness. During the waiting period, the cost of kidney stone treatment, including shockwave therapy and surgeries, is not covered. Buying a mediclaim policy before diagnosis helps you complete the waiting period and directly submit claims when you need coverage for your kidney stone treatment.

3. No Risk of Claim Rejection

   If you buy a health insurance plan before a kidney stone diagnosis, insurers cannot reject your claims. Doing so ensures that you are not only financially secure but also fully eligible to make a rightful claim without any objections.

4. Lower Premium

   Buying a mediclaim policy for kidney stones early can help you significantly lower your premium. This is because insurers will consider you a high-risk applicant if you have kidney stones and charge you a higher premium. Besides, younger people are at a low risk of developing kidney stones and thus are charged a lower premium.

Can You Buy Health Insurance After Being Diagnosed with Kidney Stones?

Yes, you can buy health insurance after being diagnosed with kidney stones. However, it is then considered a pre-existing condition and your insurance options will be limited.

This is mainly because once you are diagnosed with kidney stones, you become a high-risk applicant who is more likely to file a claim. Thus, the underwriting team may reject your policy application.

Even if an insurer accepts your policy application, you are more likely to serve a longer waiting period and have to pay a higher premium.

How to Choose the Best Health Insurance for Kidney Stones?

Here are some important things to consider when purchasing the best health insurance for kidney stones:

• High Sum Insured - Kidney stone treatment costs can escalate quickly to ₹2 lakh or more. So, opt for a high sum insured of ₹10 lakh to ₹15 lakh to cover the cost of any complications.
• Lump Sum Payout - If you have a family history of kidney stones leading to kidney failure, you should opt for a critical illness insurance plan, which offers a lump sum payout.
• Policy Inclusions - Check whether your policy covers surgeries like PCNL and open surgery costs.
• Lower Waiting Period - Opt for a health insurance plan that has a lower waiting period for kidney stones or an option to reduce it.
• Cashless Hospital Network - Make sure urology hospitals or multi-speciality hospitals near your home are part of your insurer's network to get cashless treatment.
• Low or No Sub-Limits - Go for a medical insurance plan that offers low or no sub-limit on room rent or kidney stone treatment cost.
• Pre- and Post-Hospitalisation Costs - Select a plan that offers an extensive window for diagnostic expenses, ideally covering at least 60 days of pre-hospitalisation and 90-180 days of post-hospitalisation expenses.
• Day Care Procedures - Check whether day care procedures such as RIRS, ESWL, and URSL are covered under your health policy.