Does Health Insurance Provide Coverage for Splenectomy?

Does Health Insurance Cover Splenectomy in India?

Health insurance typically covers the costs associated with critical illnesses and surgeries. Coverage for splenectomy includes the surgeon’s fees, hospital charges, anaesthesia, and other expenses related to the surgery. When purchasing a health insurance policy, it is essential to ask your provider if they cover splenectomy procedures.

However, it is also crucial to understand splenectomy in detail, along with its risk factors, procedure, and preparation, to determine the need for health insurance in the event of this condition.

Does Health Insurance Cover Splenectomy?

Most health insurance companies provide coverage for splenectomy, which is also known as spleen removal surgery. However, the extension of coverage may vary according to different policies. Therefore, it is essential to review your policy terms and conditions carefully before purchasing any product.

At Star Health, we offer coverage for splenectomy under our Star Comprehensive Insurance Policy. We also provide hassle-free claim settlements with reduced turnaround time across over 14,000 network hospitals in India.

When Does Splenectomy Become Necessary?

Splenectomy is usually performed in the treatment of a ruptured spleen due to abdominal trauma. It also treats splenomegaly, blood diseases, cancers, infections, and nonmalignant cysts or tumours, successfully treating complications and enhancing patient outcomes.

Is Splenectomy Risky?

Splenectomy is usually a safe process, but being a surgery, it may have some potential risks associated with it. Some of them include infection, bleeding, blood clots, and the organs close to the spleen, such as the pancreas, colon, and stomach, can be injured. However, one of them stands out, which is

Risks of Long-term Infection

After spleen removal, your body becomes less capable of resisting bacteria. Thus, the risk of serious infections in your body increases. Physicians typically advise against vaccines for pneumonia, influenza, Haemophilus influenzae type b (Hib), and meningococcal infection. They may also prescribe preventive antibiotics, particularly if you have other medical conditions that further increase your risk of infection.

How is a splenectomy performed?

Splenectomy is done under general anaesthesia so that the patient remains unconscious and does not experience pain during the procedure. The surgeon and surgical staff continuously monitor the patient's vital signs, including heart rate, blood pressure, and oxygen saturation, throughout the procedure.

Either a minimally invasive (laparoscopic) or open (open or traditional) procedure can be used to perform surgery, depending on the size of the spleen and the condition of the patient. Listed below are the types of surgery that are usually performed:

1.  Laparoscopic Splenectomy

In this method, the doctor makes four small cuts in the abdomen. A thin, camera-equipped tube (laparoscope) is inserted through one of the incisions, providing a video feed to a monitor. Special surgical tools are passed through the other incisions to remove and detach the spleen gently.

When the spleen is released, it is removed through one of the incisions, and all the entry points are closed. Laparoscopic splenectomy is beneficial as it involves a smaller incision size, less pain, and a shorter recovery time. Nevertheless, it might not be appropriate for all patients, particularly those with a ruptured spleen or extensive scarring from earlier surgeries.

For these patients, or if the laparoscopy is complicated, the physician recommends an open splenectomy.

2.  Open Splenectomy

In this method, a single large incision is made in the centre of the abdomen. The surgeon pushes aside muscles and tissues to reach and take out the spleen directly, afterwards closing the incision. This procedure provides greater access in the event of emergencies or for large or injured spleens.

Following the procedure, patients are supervised in the hospital for complications and recovery.

How to Prepare for a Splenectomy?

Splenectomies are performed as elective procedures (planned beforehand) or emergencies. In case of planned surgeries, you can prepare in the following ways:

• Vaccinations : It is ideally administered 10–12 weeks prior to surgery (e.g., pneumococcal, meningococcal) to ensure immunity develops at least two weeks before the operation. If delayed, vaccinations are administered after surgery.
• Smoking Cessation : Providers assist patients in quitting tobacco to improve healing and reduce surgical risks.
• Preoperative Tests : Physical exams, blood tests to assess health status, and imaging (CT/MRI scans) are conducted to plan the procedure and ensure patient safety.
• Medication Adjustments : Patients may need to fast or stop blood thinners as advised by their provider.

Elective splenectomies require careful timing to minimise infection risks of post-spleen removal, while emergency cases focus on immediate intervention. Following medical guidance on fasting, medications, and lifestyle modifications is essential for achieving optimal outcomes.