A panel convened by the PFCD (Policy Forum for Clinical Decisions) formally submitted a set of guidelines to the Insurance Regulatory and Development Authority of India (IRDAI) on Saturday, calling for standardised insurance coverage of robotic-assisted joint replacement procedures across all major health insurance policies sold in the Indian market.

The submission follows a high-profile panel discussion in which leading orthopaedic surgeons flagged that a significant proportion of patients who are clinically eligible for robotic knee and hip replacement surgeries are being denied reimbursement by insurers, forcing them to either bear full out-of-pocket costs or accept conventional procedures with inferior precision outcomes. The PFCD's document cites peer-reviewed data showing robotic-assisted surgeries reduce revision rates by up to 30 percent compared with conventional techniques.

Dr. Rajesh Malhotra, one of the panel's senior members and head of orthopaedics at AIIMS New Delhi, said the core issue is that insurers continue to classify robotic-assistance as an 'elective enhancement' rather than a clinically validated improvement in standard of care. 'When the evidence base is this strong, continuing to treat robotic surgery as a luxury is both medically indefensible and inequitable for patients who cannot self-finance,' he said in a statement accompanying the submission.

The PFCD guidelines recommend a phased approach: IRDAI should first require insurers to publish clear policies on robotic procedure coverage within 90 days, followed by a mandatory inclusion clause in all comprehensive health policies by April 2027. The panel also urges the creation of a joint working group between IRDAI, the Ministry of Health and Family Welfare, and hospital networks to establish standardised billing codes for robotic procedures — a gap that currently allows insurers to reject claims on definitional grounds.

Industry observers note that the submission arrives at a moment of heightened regulatory attention on health insurance gaps in India, with IRDAI having recently broadened its scrutiny of claim rejection rates. Hospitals operating robotic surgery programmes, including Apollo Hospitals and Fortis Healthcare, are expected to support the guidelines publicly in the coming days, adding commercial weight to what began as a clinical advocacy effort.