Is Orthopedic Surgery Covered By Insurance?

Jan 8, 2020

Is Orthopedic Surgery Covered By Insurance? | AICA OrthopedicsAfter an injury, when noninvasive procedures haven’t or can’t yield the desired results, it may be necessary to undergo orthopedic surgery to fully correct the problem. If your course of treatment is surgery, then it is essential that you have all the information upfront and organized.

One question many patients have when preparing for surgery is whether or not their procedure performed by Atlanta orthopedic specialists will be covered by insurance. Having insurance cover at least part of the cost of a surgery can alleviate some of the financial burden placed on the patient.

There are lots of factors to consider when determining if your surgery qualifies for insurance coverage, such as the cost, the surgeon, the surgical office location, and more. Here are some important things to consider to ensure your insurance provider will help cover the cost of orthopedic surgery.

The Cost of Orthopedic Surgery

If you don’t have good insurance or any insurance at all, you may think that paying out of pocket for the surgery won’t amount to much. But there’s so much more involved in an orthopedic surgery than just the surgery itself.

You have to pay for the facility, anesthesia, doctor fees, exams, and so much more. Some procedures may require an overnight stay in the hospital, which will be more expensive than an outpatient procedure.

Different types of surgeries will be more expensive than others. For example, a full hip replacement will cost more than fixing up a ligament tear. Hospital stays can range from $25,000 to $30,000. Anesthesia services can cost an additional $2000 to $4000. Consultation fees range from $100 to $500 per visit, not to mention an X-Ray, MRI, or CT scan fees on top of all of that.

When you add it all together, it’s easy to see why patients want to know if their insurance companies will help cover the overall cost of orthopedic surgery. In most cases, the answer is yes.

Is the Procedure Medically Necessary?

Luckily, this is an easy question to answer. Orthopedic surgery is almost always considered a medical necessity, meaning your insurance company is more likely to cover part of all of the expenses, depending upon your type of insurance plan.

If you do not have insurance or your insurance only pays for a portion of the surgery, you can ask if medical financing is available to help cover the remaining costs to be paid in monthly installments. Federal programs like Medicaid or Medicare may also cover orthopedic surgery costs if you qualify for these programs.

Insurance Issues are a Patient’s Responsibility

Remember, contacting your insurance company to find out exactly what is covered through your benefits is entirely a patient’s responsibility.

Take time before your surgery, maybe even before your initial consultation visit, to contact your insurance company and get the details of what is and will be covered. Request information as to what clinics and surgeons are in-network, ensuring that insurance companies will cover more of the cost than out of network specialists.

You should also ask if insurance will cover surgeon fees, hospital costs, medical equipment, medication, physical therapy, or anything else that will be required during the surgery and after, throughout the recovery process. The more informed you are before surgery, the fewer surprises you will find on your medical bills after undergoing orthopedic surgery.

If you have suffered an injury and need orthopedic surgery, AICA Orthopedics skilled orthopedic surgeons are ready and willing to help you get back on your feet once again. If the cost of orthopedic surgery is a deciding factor in your ability to make a full recovery through surgery, then be sure to take the steps today to contact your insurance company to see exactly what is covered and what falls upon the patient. Once you are prepared and everything in place, you can move forward with your recovery process for relief from injury and pain. Contact AICA Orthopedics to begin the process and schedule your consultation today.


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