Does Health Insurance Cover Orthopedic Surgery

In recent years, there has been a noticeable increase in orthopedic cases.

While many treatments are non-invasive, extreme cases may necessitate surgery.

Insurance companies are raising concerns about the coverage of orthopedic surgery due to its potential costliness, coupled with the expenses of additional tests.

Opting for health insurance could be a prudent choice in light of these considerations.

Does health insurance cover orthopedic
Most health insurance covers orthopedic surgery, including associated expenses. Check your policy for specific coverage details, and shorter procedures may fall under daycare coverage if hospitalization is less than 24 hours: Photo source (Healthline)

What is Orthopedic Surgery?

Orthopedic surgery often involves addressing various body parts such as the hip, shoulder, knee, and wrist.

These procedures target the skeletal and underlying muscle layers of the body, aiming to alleviate issues stemming from hereditary or acquired diseases, acute injuries, or accidents.

The scope of orthopedic surgery extends beyond the skeletal system to encompass ligaments, tissues, tendons, and related structures.

Two primary options for these surgeries are open surgery and arthroscopy.

Common orthopedic procedures include arthroplasty, joint surgery, and bone fracture therapy.

Here are some of the most prevalent types of orthopedic surgeries:

  1. Knee Replacement
  2. ACL Surgery
  3. Hip Replacement
  4. Shoulder Replacement
  5. Arthroscopy
  6. Joint Fusion
  7. Trigger Finger Release
  8. Ankle Repair
  9. Debridement

Also read: Do EMTs Get Health Insurance?

Is Orthopedic Surgery Covered by Health Insurance?

Broadly speaking, insurance provides extensive coverage, encompassing a wide range of aspects.

Standard health insurance policies, being comprehensive, include orthopedic disorders due to their high frequency.

The coverage extends beyond the procedure expenses, encompassing various associated costs such as pre-hospitalization, nursing, ambulance services, consultations, and other related fees.

The duration of coverage, whether permanent or temporary, depends on the policy’s extent and the specified coverage amount.

While orthopedic surgery is typically covered by most health insurance policies, it’s important to note that there might be a waiting period associated with such coverage.

Coverage for Orthopedic Surgery

Certain medical procedures become eligible for coverage under day care if they require hospitalization lasting fewer than 24 hours.

Upon acceptance, the company will bear the following expenses, provided they are part of your health insurance schedule:

  1. Room fee
  2. Surgeon fee
  3. Ambulance charge in case of an emergency
  4. Cost of prescribed medication
  5. Expenses related to blood, oxygen, operating room, and other surgical supplies

Waiting periods for orthopedic surgery are stipulated in health insurance plans.

This waiting period denotes the duration, post the health insurance plan purchase, during which claim submissions are not allowed.

The waiting time for orthopedic surgery may extend from one to two years, and for individuals with pre-existing conditions, it could be even longer.

It’s important to note that these terms and conditions can vary among different insurance providers.

Orthopedic conditions can lead to severe consequences if not addressed promptly.

Some may require orthopedic surgery, and the best way to protect your financial resources against such situations is to obtain health insurance coverage that encompasses both open and day care treatments.

Prior to submitting a claim, carefully review the terms and conditions outlined in your health insurance policy.

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