Are Benign Ovarian Cysts Treated Differently From Complex Ovarian Cysts Under Health Insurance

Yes, benign ovarian cysts are treated differently from complex ovarian cysts under health insurance. The reason behind it is their medical risk profiles, different types of treatment requirements, and potential for complications.

What are Benign Ovarian Cysts and Complex Ovarian Cysts?

An ovarian cyst is a small sac filled with fluid or semisolid material that develops on or within the ovaries. Benign ovarian cysts are harmless and may sometimes cause pain. Most of the time, ovarian cysts don’t require medical attention and resolve on their own.

Some symptoms of a benign ovarian cyst are:

Some smaller cysts cause no symptoms. In these cases, you may not even know you have a cyst. Larger cysts may cause:

• Pelvic pain or a dull ache in your back


• A feeling of fullness (bloating in your lower belly)


• Irregular periods or pain during periods


• Difficulty passing stools

On the other hand, complex ovarian cysts may contain solid components, septations, or irregular structures. These make them more clinically concerning and may require immediate medical attention or surgical treatment.

Some Symptoms of complex ovarian cysts are:

• Persistent pelvic or abdominal pain


• Bloating or swelling


• Pain during periods or intercourse


• Changes in the menstrual cycle

How Health Insurance Coverage Differs for Benign and Complex Ovarian Cysts?

Health insurance companies usually evaluate whether the ovarian cyst is benign or complex to determine the level of treatment required and the extent of coverage.

Benign ovarian cysts that do not show any symptoms and are detected incidentally may not always require immediate medical attention. And if the patient does not require hospitalisation or active treatment, health insurance companies may provide coverage that is limited. In such situations, health insurance policyholders may need an Outpatient Department (OPD) rider to claim expenses for doctor visits or diagnostic tests.

If we talk about complex ovarian cysts, they are covered comprehensively under standard health insurance policies. Complex ovarian cysts may require several diagnostic tests. These tests may include ultrasounds, MRI scans, and blood tests to understand the situation, and after that, they may treat the condition with medicines or surgery.

However, if such cases demand hospitalisation for laparoscopic or open surgery, most policies will cover medical expenses such as room charges, surgeon’s fees, and post-operative care. However, it can be subject to policy terms and conditions.