Health insurance claims for piles, fistula, anal fissures, and pilonidal sinus: Your comprehensive guide

Piles, Fistula, Anal Fissures and Pilonidal Sinus are very different from each other but to a general population their symptoms seem the same. These conditions affect people young and old given their high prevalence. While at first doctors try to treat these conditions using medication and conservative techniques, for patients with severe conditions, surgery may be the last resort. Fortunately, insurance policy comes handy to cover for the cost of treatment. In this article, we will discuss in detail coverage for treatment of these diseases including pre-surgery expenses and cover for complications.

Coverage in Insurance Policies

Surgical treatment for Piles, Fistula, Anal Fissures and Pilonidal Sinus is covered in health insurance policies. Along with hospital charges, policies cover treatment expenses incurred within 30 day period before surgery (Pre Hospitalization). In some retail or individual plans, this period could be upto 60 days. Charges for doctor consultation, lab investigations, endoscopies and medicines are covered. After surgery, your follow-up treatment for 60 days, or 2 months, is also covered (Post Hospitalization).

Remember that surgery for Piles, Fistula, Anal Fissures and Pilonidal Sinus may involve discharge on the same day (daycare procedure). These daycare surgeries are covered under insurance and you need not spend 24 hours at hospital to claim for this treatment.


A few corporate group health policies put a limit or upper cap for treatment expenses of Piles and Fistula. This means that your policy will pay for treatment only upto this amount. Pre and Post hospitalization expenses are also covered within this limit. Over and above this amount has to be borne by the patient.

Waiting Period

While corporate group health insurance does not have waiting period, retail or individual policies generally have waiting period of 12-24 months for treatment cover of Piles, Fistula, Anal Fissures and Pilonidal Sinus.

Also keep in mind that if you have been diagnosed with any of these conditions before buying your insurance plan, you must disclose these conditions in proposal form by filing up requisite details.

Cover for surgical complications

Some patients do not respond positively to the surgery and may develop complications after a few weeks or months of the surgery. In such cases, doctor may perform another surgery to fix the complications. Such surgery will also be covered by your insurance policy.

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