Losing a limb is hard enough. But for many, the next struggle comes when trying to afford a good prosthetic. Whether it’s a bionic hand like Grippy™ or a simpler mechanical option, the costs can feel overwhelming. That’s where insurance can help.
But here’s the problem: Most people don’t know how prosthetics are treated under insurance in India. Some think it’s fully covered. Others assume it’s not covered at all. And when it comes to the word “cashless,” things get even more confusing.
This article is here to clear the air. We’ll walk you through everything you need to know about getting insurance support for prosthetic devices in India—especially how cashless insurance works, what’s included, what’s not, and how to improve your chances of approval.
If you or someone you love is planning to get a prosthetic and hoping to use insurance for it, this is the guide you’ve been waiting for.
Let’s begin.
What Does Insurance Actually Cover in India?
The Basics of Health Insurance
Health insurance in India is mostly designed to cover hospitalization. It helps pay for surgeries, medicines, room charges, doctor visits, and follow-up care. Most policies focus on illnesses, injuries, and sudden medical needs.
Prosthetics, on the other hand, fall into a grey area. They are considered external medical devices. And that changes how insurance companies treat them.
Many people assume if the surgery is covered, the prosthetic should be too. But that’s not always true.
Where Prosthetics Usually Fall
In most insurance policies, prosthetics are listed under “durable medical equipment” or “assistive devices.” These terms often appear deep inside the policy wording.
Some policies cover them partially. Others exclude them completely. A few cover them only if the amputation happened during hospitalization due to an accident or major illness.
This is why reading the fine print of your policy matters.
Cashless vs Reimbursement: What’s the Difference?
What Is Cashless Insurance?
Cashless insurance means the hospital or service provider directly deals with the insurance company. You don’t have to pay upfront. The insurer settles the bill with the hospital, based on your policy terms.
It’s fast, simple, and stress-free—if it applies to your case.
For prosthetics, though, cashless insurance is not common. Most insurance providers don’t have prosthetic clinics or rehab centers in their network.
So even if you have cashless insurance, it may not apply unless the prosthetic is part of a hospital procedure.
Reimbursement Is More Likely
Most people who use insurance for prosthetics do it through reimbursement. That means you pay for the prosthetic first, and then submit all bills, reports, and documents to the insurance company.
After reviewing everything, they either approve or reject the claim.
The process can take weeks. And sometimes, the final amount you get back is much less than what you spent.
But if done right, reimbursement can still ease the financial burden.
When Does Insurance Cover Prosthetics?
Post-Hospitalization After Accidents
If your limb loss happened due to an accident and you were hospitalized, insurance is more likely to cover your prosthetic as part of the recovery.
This is especially true if you were treated under a comprehensive health plan.
In this case, your prosthetic may be covered under post-hospitalization expenses, usually within 30 to 90 days of discharge.
You will still need prescriptions, surgical records, and detailed bills.
During a Planned Surgery
If your amputation is due to illness, like diabetes or cancer, and it was a planned hospital procedure, some insurers may allow the prosthetic cost under the same claim—but only if it’s clearly mentioned in the policy.
You’ll need the doctor to include the prosthetic as part of the treatment plan before surgery. And it must be mentioned in your discharge summary.
Getting pre-authorization helps in such cases.
If You Have a Critical Illness Plan
Some critical illness plans offer a lump-sum payout upon diagnosis or surgery. Once approved, you can use this amount for anything—including prosthetics.
This isn’t reimbursement or cashless. It’s a one-time payment that gives you more control.
But again, check if your condition is listed under the illnesses covered. Not all plans include limb loss.
Through Personal Accident Cover
If your limb loss was due to an accident, and you have personal accident insurance, you may be eligible for prosthetic reimbursement.
Most policies include a specific payout for “loss of limb” or “permanent disability.”
This amount can be used to buy a prosthetic, among other things. It’s not direct cashless coverage, but it’s one of the most straightforward ways to get financial help.
What Kinds of Prosthetics Are Usually Covered?
Basic Functional Limbs
Insurance companies are more likely to approve coverage for basic functional limbs—the kind used to restore simple movement or balance.
These include:
- Mechanical prosthetic hands or legs
- Cosmetic limbs for balance and posture
- Entry-level models without electronics
They’re seen as medically necessary and cost less than advanced devices.
Advanced Bionic Hands Like Grippy™
High-tech prosthetics, like our Grippy™ bionic hand, are less likely to be covered in full. They’re often classified as advanced or luxury devices.
But don’t lose hope. Some insurers approve partial reimbursement if you can show:
- Medical need
- Doctor’s recommendation
- Breakdown of features and benefits
- Cost comparison with basic models
We help our clients prepare all these documents for better approval chances.
Custom or Pediatric Prosthetics
Customized prosthetics or those made for children may get special attention, especially if prescribed by a specialist.
Some insurers may cover these under “custom medical appliances”, but approvals take time.
Always include full specs, doctor’s reports, and photos when submitting your claim.
What Documents Do You Need to File a Prosthetic Claim?
The Paperwork Makes All the Difference
When it comes to insurance, documentation is everything. The stronger your paperwork, the better your chances of getting your prosthetic approved—either fully or partially.
This applies whether you are going for reimbursement or hoping for pre-approval under a cashless claim.
Must-Have Documents
Here’s what most insurance companies ask for when processing a prosthetic-related claim:
- Doctor’s prescription stating the need for a prosthetic.
- Discharge summary from the hospital where surgery or amputation was done.
- Surgery report or amputation details with ICD code.
- Diagnostic reports (X-rays, CT, MRI, etc.).
- Invoice or quotation from the prosthetic provider.
- Proof of payment (if reimbursement).
- Aadhar and PAN card copies.
- Bank details for claim settlement.
The doctor’s note should clearly mention the prosthetic is medically necessary, not optional or cosmetic.
How Robobionics Helps
At Robobionics, we understand that dealing with insurance paperwork is overwhelming—especially during recovery. That’s why we help our clients at every step.
We provide:
- Detailed invoices with GST and model info.
- Product descriptions for insurance teams.
- Letters of support from your fitting specialist.
- Photos and measurements when needed.
All this helps your claim look more complete and genuine, improving your odds of approval.
How to Know If Your Insurance Plan Covers Prosthetics
Read the Fine Print or Ask Directly
Most people buy insurance but don’t read the fine print until it’s too late. That’s completely normal. But when it comes to prosthetics, you really need to check.
Look for keywords like:
- Durable medical equipment
- Artificial limbs
- Orthotic and prosthetic devices
- Post-hospitalization coverage
- Rehabilitation or mobility aids
If your policy document doesn’t clearly say yes or no, call your insurer or TPA (Third-Party Administrator) and ask directly.
Ask the Right Questions
When you contact your insurer, here are a few specific questions that can help:
- Is a prosthetic limb covered under my current policy?
- Do I need to be hospitalized for the prosthetic to be covered?
- Is cashless insurance available for prosthetics, or only reimbursement?
- Are there any limits or caps on the prosthetic cost?
- Will you cover advanced prosthetics or only basic ones?
- Do I need pre-authorization before purchasing?
Record the answers or get them in writing if possible. It helps later if there are any disputes during the claim process.
What to Do If Your Insurance Denies the Claim
Don’t Panic. You Have Options.
It’s common for prosthetic claims to get denied on the first try. That doesn’t mean your case is closed. It just means you need to respond with stronger documentation or a new approach.
Most insurers will give you a reason for the rejection—maybe missing paperwork, unclear medical need, or the device being considered cosmetic.
This feedback gives you a direction to improve your case.
Appeal with More Information
In most cases, you can appeal a rejected claim. You’ll need to submit:
- A written explanation from your doctor.
- Product comparisons showing why a basic limb is not enough.
- Supporting documents like disability certificates or rehab reports.
Insurance companies are more willing to reconsider when you show effort and clear medical backing.
At Robobionics, we help you write this appeal in a way that insurance teams understand clearly.
Try Multiple Paths
Sometimes, insurers will cover only a portion of the prosthetic’s cost. You can then explore other sources for the rest, such as:
- Government disability schemes
- CSR grants or NGO support
- Crowdfunding for medical needs
- EMI options (which we offer directly)
Combining insurance reimbursement with other funding options often gets you closer to affording the device you actually need—not just the one the policy prefers.
What About Government Health Schemes?
Ayushman Bharat and Prosthetics
The Ayushman Bharat PM-JAY scheme provides cashless hospitalization up to ₹5 lakh for poor and vulnerable families. Some states allow coverage for post-surgical rehab, including prosthetics.
However, this depends heavily on:
- Your state’s rules
- The empanelled hospitals
- Whether your prosthetic supplier is part of the system
It’s rare, but not impossible.
You can check eligibility on the Ayushman Bharat website or speak to your district health officer.
State Disability Boards
Many states have special schemes for persons with disabilities. They often include subsidies or financial aid for prosthetics, especially for economically weaker sections.
These are not insurance programs but can supplement what insurance won’t cover.
For example, states like Tamil Nadu, Maharashtra, and Kerala offer support for basic prosthetics through social welfare departments.
We can help guide you toward the right contacts in your area.
Common Challenges People Face With Insurance for Prosthetics
Confusing Policy Language
One of the biggest problems is how insurance documents are written. Most policy wordings are full of complex terms. Words like “durable medical equipment,” “orthotic device,” and “post-operative rehabilitation” often appear without clear meaning.
This confuses families. They may believe prosthetics are covered, only to realize too late that the policy excludes them or offers only partial support.
We always recommend reading your policy slowly, or even better, having someone explain it in simple words.
Miscommunication With TPAs and Insurers
Even when prosthetic coverage is technically allowed, TPAs (Third-Party Administrators) may not understand how these devices work. They might assume a bionic hand is a cosmetic item or a luxury product.
This leads to rejections that could have been avoided with better communication.
That’s why we help you prepare the right documents, medical language, and photos. We also guide your doctor on how to phrase their prescription in ways insurers recognize.
Lack of Empanelled Prosthetic Providers
In cashless insurance, the insurer settles the bill directly with approved hospitals or vendors. Unfortunately, very few prosthetic clinics or providers are empanelled with insurance companies in India.
This means even if your policy says “cashless available,” it likely won’t apply to your prosthetic purchase.
That’s why most prosthetic claims are handled through reimbursement.
How to Increase Your Chances of Getting Approved
Start With the Right Doctor’s Note
Insurance companies trust doctors. A strong doctor’s prescription can make or break your claim. It should:
- Clearly mention the medical need for a prosthetic.
- State the limb loss and cause (accident, illness, surgery).
- Explain why a specific prosthetic is recommended.
- Avoid using casual terms like “optional” or “aesthetic.”
It’s okay to ask your doctor to revise the note to match these points. Most are happy to help when they understand the purpose.
Include a Cost Comparison
Sometimes insurers want to know why you’re choosing a specific model. If you’re requesting reimbursement for an advanced prosthetic like Grippy™, it’s helpful to include:
- A price quote from a basic model.
- A price quote from Grippy™ or your selected option.
- A short explanation of the key differences and why the basic one won’t meet your needs.
This shows you’ve done your homework and aren’t simply choosing the most expensive option. It frames your decision as medically important, not just personal preference.
Submit All Paperwork Together
Many claims are delayed or denied because of missing documents. Always double-check that your submission includes:
- Doctor’s prescription.
- Hospital discharge summary.
- Diagnostic reports.
- Invoice and proof of payment.
- Your ID and bank details.
Send them in one neat file or envelope. Organize by date and keep a copy for your own records.
Robobionics helps prepare these bundles for you. We also give you digital copies to email or upload easily.
Get Pre-Authorization If Possible
Some insurance companies allow you to apply for pre-authorization, even for reimbursement. That means you send them an estimate and medical note before buying the prosthetic.
They’ll respond with a letter saying how much they’re willing to cover.
This is a great way to avoid surprises and plan your funding properly.
Real Stories, Real Impact
Priya’s Journey
Priya, a 26-year-old software engineer from Hyderabad, lost her right hand in an industrial accident. She was covered under her company’s group health insurance, but the policy didn’t mention prosthetics clearly.
With our help, she gathered the right paperwork, got a letter from her surgeon, and applied for reimbursement after purchasing her Grippy™ hand.
Her insurer initially rejected the claim. But after an appeal with added medical explanation, they approved 50% of the cost—₹1.2 lakh—within 40 days.
This reduced her financial pressure and let her focus fully on rehab.
Abdul’s Case
Abdul, a daily-wage worker from Bhopal, had no private insurance but was registered under Ayushman Bharat through his ration card. After a train accident, he lost his left arm.
We connected with a local government hospital and helped process his claim under the state’s disability aid program. His mechanical hand was fully covered.
His story reminds us that even without traditional insurance, there are paths forward.
We’ve supported over 300+ families with such journeys—each one different, each one meaningful.
What to Do If You Have No Insurance
Don’t Lose Hope
If you don’t have insurance, it’s still possible to afford a prosthetic. We’ve worked with many clients in this position, and we know how to find solutions.
Here are a few paths you can explore:
- EMI plans with zero or low interest.
- Crowdfunding platforms like Ketto or Milaap.
- CSR foundations that support prosthetics for underprivileged users.
- District disability welfare offices for government subsidies.
At Robobionics, we help you find the right fit. Our goal is to remove the fear and confusion and replace it with a real plan.
EMI as a Reliable Alternative to Insurance
Why EMI Can Be a Smart Option
In many cases, insurance doesn’t offer full coverage—or any coverage at all. That’s where EMI comes in as a dependable solution. You don’t need to wait for approvals, chase paperwork, or risk rejections. You get the prosthetic you need now, and pay for it slowly, in a way that fits your monthly budget.
EMI gives you the freedom to choose the right prosthetic for your lifestyle—not just the one insurance is willing to approve.
At Robobionics, we offer flexible EMI options for all our products, including Grippy™, Grippy Mech Hand, and other devices.
EMI Is Often Faster Than Insurance
Unlike insurance, where the process can take weeks or even months, EMI approval often happens within a few days. There’s less paperwork, less waiting, and more certainty.
This is especially helpful for those who need their prosthetic urgently—to return to work, school, or daily life.
We work with EMI partners who understand your needs and focus on making the process simple and transparent.
How Robobionics Supports You Beyond the Device
Helping You Understand Your Policy
When you come to Robobionics, you don’t just get a prosthetic. You get a partner who walks with you through the insurance journey too.
Our in-house team reviews your insurance policy, explains what is and isn’t covered, and helps you prepare the right documents. We don’t make false promises—but we do everything in our power to help you claim what you’re entitled to.
If your policy doesn’t mention prosthetics clearly, we help you draft letters, collect quotes, and communicate with your insurer the right way.
Supporting Appeals and Follow-Ups
If your initial claim is rejected, we don’t leave you hanging. We help you file an appeal with the insurer, supported by detailed medical explanations, technical breakdowns, and real need-based arguments.
Our team knows what insurance reviewers look for—and we prepare your case accordingly.
We’ve seen clients go from rejection to partial approval within a matter of weeks, just by presenting the right story in the right format.
Helping You Choose the Right Financial Path
We know every person’s situation is different. Some have group insurance, others have none. Some can manage a large down payment, while others need full financing.
That’s why we don’t push any one method. Instead, we listen first, understand your needs, and then guide you to the best solution—whether that’s insurance, EMI, a government scheme, or a combination of these.
Our only goal is this: to get the best prosthetic in your hands, with the least possible stress.
Final Thoughts: You Have More Options Than You Think
We know the world of insurance and prosthetics can feel complicated. The forms, the jargon, the delays—it can all be too much, especially when you’re recovering from a major life change.
But here’s the truth: you are not alone. And you are not out of options.
Whether through insurance, EMI, or government support, there are real, working solutions out there—and Robobionics is here to help you find them.
You don’t need to settle for less. You don’t have to wait forever. And you definitely don’t need to face this process alone.
You deserve a high-quality prosthetic that helps you live, move, and thrive with dignity. And we’ll do everything we can to make that happen.
Your Next Step Starts Here
If you’re planning to get a prosthetic, or just exploring your options, the first step is simple: book a free demo with our team.
We’ll walk you through:
- How Grippy™ works and what makes it unique.
- Your insurance options and how to check your coverage.
- EMI plans tailored to your income and budget.
- What documents to prepare and how to file your claim.
There’s no pressure. Just honest guidance, expert support, and the freedom to choose what’s best for you.
Visit https://www.robobionics.in/bookdemo/ to schedule your session today.
You’ve already faced the hard part. Now let us help you make the rest easier—with technology, empathy, and real-world solutions that work.
Your next chapter is waiting. And it’s one worth stepping into—confidently, fully, and with both hands open.