INSURANCE & CASHLESS 2026
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.
THE BASICS
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:Â fully covered
Hospital room (per policy limit):Â covered up to daily room rent cap
Implants & devices:Â covered within sum insured limits
Robotic technology fee:Â covered by most insurers
Pre-hospitalisation (30-60 days):Â diagnostics, consultation
Post-hospitalisation (60-90 days):Â follow-up, physiotherapy, medicines
ICU / consumables:Â covered if medically needed
Warning Signs — See A Surgeon
Persistent or worsening knee pain
Swelling, warmth, or redness
Fever with knee symptoms
Knee "giving way" or instability
New clicking or clunking sounds
Reduced walking distance
Progressive stiffness
CASHLESS NETWORK
Major Insurers with Cashless Tie-ups at DHS
| Insurer / TPA | Type | Typical Waiting Period |
|---|---|---|
| Star Health & Allied Insurance | Standalone Health | 24 months |
| HDFC ERGO Health | General Insurance | 24–36 months |
| Bajaj Allianz Health Insurance | General Insurance | 24 months |
| ICICI Lombard | General Insurance | 24–48 months |
| Niva Bupa (formerly Max Bupa) | Standalone Health | 24–36 months |
| Care Health Insurance | Standalone Health | 24–48 months |
| Tata AIG General Insurance | General Insurance | 24–48 months |
| New India Assurance | PSU Insurer | 24–48 months |
| Oriental / National / United India | PSU Insurer | 24–48 months |
| Reliance General Insurance | General Insurance | 24–36 months |
| SBI General Insurance | General Insurance | 24–36 months |
| Future Generali | General Insurance | 24–48 months |
| Ayushman Bharat (PMJAY) | Government Scheme | No waiting period (eligibility-based) |
AYUSHMAN BHARAT
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.
STEP-BY-STEP
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.
INSURANCE FAQ
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.
EXPLORE
Related Information
Check Your Cashless Eligibility
Share your policy — we’ll confirm cashless cover in under an hour. No paperwork, no commitment.