Is Kidney Biopsy Covered Under Insurance?

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A kidney biopsy is a procedure that involves sampling a small portion of tissue to diagnose kidney diseases. Yes, kidney biopsies are covered by health insurance, as long as the procedure is medically necessary and performed in a hospital.


A renal biopsy is categorised as day-care or inpatient surgery. Its coverage is clearly defined in the list of procedures covered by many insurers. For example, the IRDAI-approved wordings list “Renal Biopsy” (Kidney Endoscopy and Biopsy) as a payable procedure.


This implies that when a healthcare professional requests a biopsy to examine kidney complications, the biopsy expenses would be covered under a default policy (after the waiting period). Keep reading to know more.


Coverage Details


The following table describes the coverage aspects of the kidney biopsy procedure:


























Aspect



Details



Procedure type



Kidney biopsy is considered to be a day-care or temporary hospitalisation procedure (most of the time, a few hours).



Insurance coverage



Covered. A renal biopsy is covered under standard health plans.



Waiting period



There are standard waiting periods (30-day wait (first time), 2-4 years wait (pre-existing conditions).



If CKD (Chronic Kidney Disease) is pre-existing



In case you had chronic kidney disease at purchase: related claims are excluded until the PED waiting period has passed (IRDAI permits chronic kidney disease as a pre-existing condition to be excluded).



How Insurers Treat Kidney Biopsy


Since a kidney biopsy is normally performed under local anaesthesia and a minimum day stay, some insurance companies might consider it a day-care procedure. Outpatient/day-care surgeries, such as kidney biopsies, are also becoming common procedures reimbursed by modern plans.


In practice, most insurers pay for the biopsy expense as part of hospitalisation charges (often under a sub-limit or as part of nephrology treatment). Patients need to make sure that the biopsy is pre-approved (for a claim without cash) and that the hospital claims it is a registered day-care procedure.


Important Points to Remember


One caveat is pre-existing kidney disease. IRDAI guidelines list chronic kidney diseases (like glomerulonephritis) as excludable if they existed at policy inception. In case the policyholder already has CKD at acquisition, insurers can exclude any claim concerning this condition.


Under these circumstances, a biopsy performed to determine the presence of a known disease may not be covered until the end of the pre-existing disease waiting period (generally 2-4 years). Otherwise, for a new kidney ailment, the biopsy cost is covered.


A kidney biopsy is a covered benefit under Indian health insurance, provided that it is medically required. The policyholder must keep in mind that there is a standard waiting period and should be sensitive to any provisions regarding pre-existing renal disease.


With those conditions met, the biopsy bill can be claimed like any other hospitalisation expense.