Health Insurance generally covers Orthopedic surgery. Orthopedic surgery is an essential medical procedure that helps in the necessary treatment of the procedure for the treatment for the joints, bones, and muscles. 

Various types of orthopedic surgeries namely joint replacements, reconstruction of the ligaments, repair of fractures, joint replacements, and other different needful orthopedic surgeries. The coverage amounts and details might vary according to the medical insurance plan being used. 

The deductibles, co-pays, and pre-authorization requirements would be included in the coverage itself. Also, one should have a detailed discussion with the insurance provider on the plan they would be selected according to their need and try to get a grip on the full coverage for the surgery.

Orthopedic Surgery 

Whenever we talk about bones, ligaments, joints, knees, or hips it is covered under the stream of orthopedics. The insurance coverage for the entire surgical treatment ortho related issues like joint injuries, ligament reconstructions, muscles, tendons, etc. 

The injury can be due to some accident, previous hurt, any form of bone-based disease like arthritis, some acute damage, or even some hereditary issue of the joints, bones or even ligaments, Arthroscopy is the medical name for this surgery.

Always consult with an orthopedic doctor in Delhi whether you need the surgery as every person has a different metabolism and the intensity of the injury or disease is different. Arthritis or spinal cord correction surgeries would be covered by corporate insurance. 

Also, it would be best to talk to your insurance agent before going for any form of orthopedic surgery.

The Most Common Orthopedic Surgeries 

The most common surgeries performed according to the severity and condition of the various conditions and injuries are as follows: -

●       Replacement of the Joints 

In this surgery, the affected joint from arthritis or a damaged joint from some earlier injury is replaced with a prosthetic joint made out of alloy, ceramic, or plastic.

●       Repairing of Fracture 

Fracture repairing involves the simple re-aligning of broken bones with the help of crews, plates, or rods. It stabilizes the affected area and also helps in further healing ultimately.

●       Spinal Fusion 

Through this surgery, two or more vertebrae are joined together. Usually, bone grafting or implanting is used to stabilize the spine and reduce the pain which is caused due to the degenerated disc or spinal deformity.

●       Arthroscopy 

This is one of the most minimally invasive surgeries where a camera known as the arthroscope is inserted into the joints to understand and diagnose for further treatment of conditions like cartilage damage, ligament torn, and inflamed synovium.

●       Hip Replacement 

The damaged hip joints are replaced with prosthetic joints made of metal, ceramic, or plastic. It further helps in healing and better functioning of the hip joints reducing acute pain one goes. This is also known as hip arthroplasty.

●       ACL Reconstruction 

Anterior Cruciate Ligament or commonly known as ACL reconstruction is generally done to repair the torn ligament or the ACL of the knee. During the reconstruction, the damaged ligament is grafted and it is taken from the patient's own tendon or a donor's tendon can also be used.

●       Repairing of the Meniscus

In the knee, there is a C-shaped cartilage which is known as a meniscus. The repairing of the meniscus helps in repairing the torn meniscus by stitching or suturing, as known medically, the torn edges together.

●       Repairing of the Rotator Cuff 

In the shoulder the rotator cuff tendon, and in the repairing surgery the torn tendon is re-attached with the humerus bone.

Health Insurance Coverage for Orthopedic Surgery 

Talking about health insurance coverage for all orthopedic surgeries includes all the A to Z costs of the surgery. Of course, the extra expenses like the extra medicines, or if during surgery extra blood is needed then that has to be paid by the patient personally. 

Also, it should be noted that insurance coverage for these surgeries can vary according to the type of insurance plan selected and the type of surgery being done. Other than that all the necessary orthopedic procedures are covered fully. 

Let us now understand a few essential points about health insurance coverage for all types of orthopedic surgeries:

●       The Deductibles Plus the Co-Payments 

In health insurance plans, there are two essential parts, the deductibles, and the co-payments. Deductibles are the sum amount of money the insured has agreed to pay towards the cover claimed from the policy for the surgery. 

And the co-payments are a specific amount that the insurer has to pay during the time of claim. So, it is essential that before you go for any ortho-related surgery do check on both the deductible and co-payment policy of your health insurance, to avoid confusion.

●       Essentially Medical Procedures 

While talking about essential medical procedures, do check your policy whether it would be covering your surgery. Medical insurance covers treatments like repairing ligaments, joint replacements, fracture surgeries, and other surgeries which would be a treatment for mobility and severe injuries. 

Cosmetic and elective surgeries which are not so essential are not covered, have good knowledge before claiming.

●       Prior Authorization and Having a Second Opinion 

Do check that all your needful medical documents are submitted to the insurance company before the claim. So be in touch with the best hip replacement doctor you are consulting and get all the documents prior to the surgery. 

Sometimes when it is a serious surgery with severity the insurance company would ask for a second opinion. So, do clarify with your insurance agent so that during the claim you do not face any complications.

●       Pre- Authorization

The pre-authorization policy is applicable with few policy providers, where your ortho surgeon would be needing prior approval from the company before the surgery. This policy is just to protect essential medical procedures meeting the insurance plan criteria fully.

It is important to have a full review of your own medical insurance policy and directly understand the claim from the insurance provider for a hassle-free claim procedure.be clear about the limitations, and coverage criteria of the ortho surgery and other essential things. 

●      Waiting Period

Before the surgery do clear about the waiting periods pre-surgery like getting the date of the hip replacement surgeon or other essential things. As the claim has to be in advance so clear about your wait period with your surgeon. So that during the claim there is no confusion.