Many policies classify peptic ulcers as pre-existing conditions (PECs) if the policyholder is affected by this condition before buying the plan.
The lining of the stomach, lower oesophagus, or upper portion of the small intestine might develop open sores called peptic ulcers. These ulcers need to be diagnosed right away, given care, and, in extreme situations, may require hospitalization.
They are frequently brought on by Helicobacter pylori infections or long-term nonsteroidal anti-inflammatory drugs (NSAIDs) usage. Thus, it is crucial for you to find out if your health insurance plan covers treatment for peptic ulcers.
Keep reading for detailed insight!
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Does Peptic Ulcer Coverage Exist in Health Insurance?
Yes, the majority of comprehensive health insurance plans include the treatment of peptic ulcers. Usually, coverage entails endoscopies, prescription drugs, diagnostic testing, hospital stays, and, if necessary, surgery. However, waiting periods, exclusions, and insurance type all affect how much coverage is provided.
Which Types of Peptic Ulcer Treatment Are Covered?
Depending on the plan, health insurance often covers both inpatient and outpatient treatments:
● Hospitalization: The costs of hospitalisation, including room rent, critical care unit fees, and surgeon's fees, are covered if the ulcer causes bleeding or perforation or requires surgery.
● Diagnostics: Plans that cover pre- and post-hospitalization costs may reimburse imaging procedures that are required for diagnosis, such as endoscopy, upper gastrointestinal series, or Computed Tomography (CT) scans.
● Medication: If applicable, pharmacy coverage often covers antacids, proton pump inhibitors (PPIs), and Helicobacter pylori antibiotics used both during and after hospitalization.
● Follow-up Care: For a set period of time (often 30 to 180 days), the insurance plan may pay for follow-up visits following hospitalization.
Are There Any Waiting Periods for Peptic Ulcer Coverage?
Many policies classify peptic ulcers as pre-existing conditions (PECs) if the policyholder is affected by this condition before buying the plan. Depending on the insurer, PECs often have a waiting time ranging from 12 to 36 months. If information is not disclosed, the claim may be denied for non-disclosure or deception.
Insurers offer an optional cover that allows individuals to reduce the waiting period in exchange for a higher premium. Furthermore, a 30-day initial waiting time from the commencement date may also be imposed by certain plans for all non-accidental illnesses.
Does the Diagnosis of Peptic Ulcers Cover Endoscopy?
Endoscopy is an essential diagnostic technique for peptic ulcers. This treatment is usually covered by health insurance that covers diagnostic costs, particularly those spent during hospitalization. It may also be covered under outpatient department (OPD) coverage in some plans.
Since not all insurance plans cover OPD, it is essential to choose a health insurance plan that provides coverage for such procedures.
Does Health Insurance Cover Peptic Ulcer Complications?
Surgery and immediate hospitalization are frequently necessary for severe peptic ulcer complications. These circumstances are covered by standard hospitalization benefits if the patient is in the hospital for more than twenty-four hours.
Critical care, blood transfusions, surgical repair, and post-surgery recovery expenses are frequently reimbursed, depending on the insurance's terms and submits.
Are Day-Care Treatments for Peptic Ulcers Covered?
While most peptic ulcer treatments require full-day hospitalization, some insurers cover endoscopy or minor procedures such as day-care treatments. So, if your policy includes day-care coverage, ensure that the procedure is listed in the insurer’s day-care list.
For example, the insurer provides a wide array of day-care procedures under its comprehensive health insurance policies.
Are Peptic Ulcers Covered Under Individual and Family Floater Plans?
Yes. Both individual and health insurance plans for family offer coverage for peptic ulcers, subject to the terms mentioned above. However, as the sum insured is divided into family floater plans, payment may be impacted by several concurrent claims.
How to Choose a Health Insurance Plan for Peptic Ulcer Treatment?
Consider the following factors while selecting a health insurance plan for ulcer-related treatment:
● Pre-hospitalization and post-hospitalization coverage (at least 30 and 180 days)
● Shorter waiting periods for PECs
● OPD and diagnostic coverage
● Day-care procedure inclusion
● High sum insured to manage complications or ICU expenses
Approach to Peptic Ulcer Coverage
Typically, the insurer offering health plans cover peptic ulcer treatment under both individual and floater options. Their policies might include:
● Inpatient hospitalization for ulcers and related surgeries
● Diagnostic procedures like endoscopy and scans
● Pre- and post-hospitalization expenses (60 and 180 days, depending upon the policy)
● Day-care procedure coverage (as present in policy documents)
● Optional riders for OPD and wellness
