DHS Multispecialty Hospital, Sunrise Park, Gurukul, Ahmedabad

Knee Replacement Insurance in Ahmedabad

Complete insurance playbook for knee replacement in Ahmedabad — cashless hospital list, Ayushman Bharat, TPA process, and what to expect from Dr Hardik Shah's team at DHS Multispecialty Hospital.

Is Knee Replacement Covered by Health Insurance?

Yes — knee replacement surgery, including robotic knee replacement, is covered by virtually every standard health insurance policy in India. Because it's classified as a medically necessary procedure, insurers cannot deny coverage once the waiting period is complete and pre-authorisation is approved.

At DHS Multispecialty Hospital in Ahmedabad, over 80% of Dr Hardik Shah's knee replacement patients use cashless insurance, meaning they pay nothing (or only the policy excess) at discharge. Our admin team handles all paperwork — pre-authorisation, TPA coordination, and claim processing — so you can focus on recovery.

What's Typically Covered

  • Surgery fees & OT charges: fully covered
  • Hospital room (per policy limit): covered up to daily room rent cap
  • Implants & devices: covered within sum insured limits
  • Robotic technology fee: covered by most insurers
  • Pre-hospitalisation (30-60 days): diagnostics, consultation
  • Post-hospitalisation (60-90 days): follow-up, physiotherapy, medicines
  • ICU / consumables: covered if medically needed

Quick Facts

  • 40+ insurer cashless tie-ups
  • Ayushman Bharat accepted
  • Corporate plans supported
  • TPA team on-site
  • Pre-auth usually under 24h
  • No unexpected bills

Major Insurers with Cashless Tie-ups at DHS

Insurer / TPATypeTypical Waiting Period
Star Health & Allied InsuranceStandalone Health24 months
HDFC ERGO HealthGeneral Insurance24-36 months
Bajaj Allianz Health InsuranceGeneral Insurance24 months
ICICI LombardGeneral Insurance24-48 months
Niva Bupa (formerly Max Bupa)Standalone Health24-36 months
Care Health InsuranceStandalone Health24-48 months
Tata AIG General InsuranceGeneral Insurance24-48 months
New India AssurancePSU Insurer24-48 months
Oriental / National / United IndiaPSU Insurer24-48 months
Reliance General InsuranceGeneral Insurance24-36 months
SBI General InsuranceGeneral Insurance24-36 months
Future GeneraliGeneral Insurance24-48 months
Ayushman Bharat (PMJAY)Government SchemeNo waiting period (eligibility-based)

Call +91 97277 26933 to verify your specific policy is in the cashless network.

Knee Replacement Under Ayushman Bharat (PM-JAY)

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) provides health insurance cover of up to ₹5 lakh per family per year for eligible families. Knee replacement is a covered procedure at empanelled hospitals across India.

Who's Eligible?

  • Families listed in SECC 2011 deprivation database
  • Families with PM-JAY e-card or ration-linked enrollment
  • Some Gujarat state extensions under MA Yojana / MA Vatsalya

How to Use Your PM-JAY Card at DHS

  • Bring your Ayushman e-card + Aadhaar
  • Admin team verifies eligibility on the PM-JAY portal
  • Pre-authorisation raised — usually same-day approval
  • Treatment is fully cashless up to scheme limits
  • Eligibility helpline: 14555 (toll-free)

Not Sure If You're Covered?

Call us with your policy name and number — we'll confirm your cashless eligibility, typical room limits, and any sub-limits within minutes. No commitment, no paperwork needed upfront.

How Cashless Knee Replacement Works at DHS

1. Consult Dr Shah

Initial consultation to confirm surgical fitness, treatment plan, and implant selection.

2. Share Policy Details

Email or WhatsApp your insurance card — we verify cashless eligibility same day.

3. Pre-Authorisation

Our TPA desk raises the pre-auth request with all diagnostics. Usually approved within 24 hours.

4. Admission & Surgery

Come in on the surgery date. No deposit needed if pre-auth is approved (except policy excess).

5. Discharge

Final bill is settled with the insurer directly. You sign the final discharge summary — nothing else.

6. Post-Op Claims

We provide full documentation for your 60-90 day post-hospitalisation reimbursement claim.

Frequently Asked Questions

Does my policy's waiting period apply to knee replacement?

Yes. Most policies have a 24-48 month waiting period for planned orthopedic surgeries. If your policy is new, check the exact waiting period in your schedule or call the insurer.

Can I upgrade my cover just before surgery?

No — insurers apply fresh waiting periods to any upgraded top-up, so an upgrade right before surgery doesn't help. Consider planning insurance 2-3 years in advance of surgery if possible.

What happens if pre-authorisation is rejected?

Rejections are rare once the policy's waiting period is complete. If rejected, we help with a reimbursement claim instead — pay upfront, claim back after surgery with full documentation.

Is the robotic technology fee covered?

Most insurers cover it as part of the overall procedure cost. A handful have sub-limits on "advanced technology" — we flag this upfront during pre-auth.

Can I use two insurance policies together?

Yes — coordination of benefits is allowed. Primary insurer pays first, secondary covers the balance up to your combined sum insured. Our TPA team handles dual claims.

Are pre-op diagnostic tests covered?

Yes — diagnostics within 30-60 days before admission are covered under pre-hospitalisation benefits. Save receipts and submit with your claim.

Check Your Cashless Eligibility

Share your policy — we'll confirm cashless cover in under an hour. No paperwork, no commitment.

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