Will cos cover post mucor surgeries? Opinions differ

Nagpur: As mucormycocis is also leading to surgeries for removing facial bones or eyes to save patients’ lives, there are questions whether plastic surgeries that may follow, for treating the disfigurement, would be covered by health insurers.
The surgeries are expensive with the bills running into Rs5 to Rs6 lakh in some cases, said doctors.
In the normal course, insurance companies do not pay for plastic surgeries as these are considered cosmetic treatment and not necessary to save a patient’s life or maintain functionality of a body part.
The reconstructive surgeries would follow at least three months after the primary procedure due to mucormycosis. With the surge in mucormycosis cases is nearly a month old yet, patients are yet to face the question of insurance claim.
As TOI talked to insurance companies and associated professionals, there was a mixed response.
In what may be good news of the mucor patients, professional related to some of the private companies said the expenses would be covered.
Manoj Aya from M/s GNTL Financial Services, an insurance consultancy, said it was confirmed by the private company he dealt with that even plastic surgery required after mucormycosis will be covered.
“I have consulted a team of doctors scrutinizing the claims. They said this is being taken as a Covid-related complication due to which reconstructive plastic surgeries will be paid for,” said Aya.
Dr Darshan Rewanwar, a plastic surgeon from the city, said surgeries should be covered by the insurance companies. The surgeries for removal of body parts have to be done for preventing the infection spread. This is followed by operations to maintain the functionality of the body part. In case of eyes, it is needed to maintain the symmetry, he said.
However, an official of a private hospital who reverted after talking to an insurance company, said plastic surgeries are not likely to be covered. This is because it is an external treatment and not needed to cure the disease as such.
Officials of two other companies said they haven’t come up with any such case so far at the regional office level. It is likely that as a special case, expenses on mucormycocis patients’ plastic surgeries may be reimbursed. “There have been no clear instructions yet,” they said.
“The general rule is that, it is evaluated whether a particular surgery is needed for the patient to carry on his day to day work. If it can happen even without the plastic surgery, the expenses may not be reimbursed or covered under cashless schemes,” said an official.