Health Insurance Copay Explained : Expenses, Coverage, and Fistula Surgery vs Medicines

An 18% copay means that a small fixed percentage of the total hospital bill has to be paid by the patient, while the remaining amount is covered by the insurance company. For example, if the total bill is ₹1,00,000, the patient pays ₹18,000 and the insurer pays ₹82,000.

In your case, most of the amount has already been adjusted, and you only need to pay a minimal amount from your side. The room provided under the policy is a twin-sharing room. Normally, non-medical expenses like attendant or consumable charges may apply, but these have been minimized or waived off for you. Your policy is valid until 31st March 2026, and since you already have a prescription, you can get admitted directly without any issue.

Regarding fistula, it cannot be cured with medicines alone and requires surgical treatment. Laser surgery is the preferred option as it has very minimal pain, a very low risk of infection, and a much lower chance of recurrence compared to open surgery. You may also take a second opinion if needed before proceeding.