Does Health Insurance Cover Orthopedic Surgery?
Bone and muscle-related impediments often require orthopaedic treatment. Orthopaedic treatment is generally done only amongst the elderly. Unfortunately, due to exercising a sedentary life, even youths are being diagnosed with similar conditions of late. Orthopaedic treatments are generally pricey. So, unless you have planned in advance, it could be impervious to your finances. You may be wondering if the health insurance policy covers Orthopaedic surgery. Well, read ahead to find out!
Orthopaedic Surgery
Orthopaedic Surgery is a medical procedure for a person suffering from body deformities. These could be affected by disease, injury, or inheritable causes.
Orthopaedic treatment is generally distributed to the musculoskeletal system of the human body. This system includes bones, ligaments, cartilage, connective tissue, and tendons.
The two commonly suggested orthopaedic treatments are arthroscopy and open surgery. And in the case of open surgery, a patient may need to be admitted to a hospital for many days. Still, in the case of arthroscopy, it's generally a daycare procedure that spans lower than 24 hours. Therefore, you may not need to be admitted.
Types of Orthopaedic Surgeries
The surgeries could be performed on the shoulder, hip, spine, ankle, wrist, knee, elbow, etc., predicated on these regions. Below are some of the treatments generally prescribed:
- Anterior cruciate ligament (ACL) reconstruction surgery
- Spinal surgeries
- Osteotomy
- Shoulder replacement surgery
- Knee arthroscopy
- Shoulder arthroscopy
- Joint arthroscopy
- Knee replacement surgery
- Bone fracture repair
- Soft tissue repair
- Ankle repair
- Hip replacement surgery
- Trigger finger rRelease
- Debridement
Orthopaedic Surgery Cost in India
Orthopaedic treatments can be pricey in India due to the expansive procedures. To help you get a better idea, below are some cases of common orthopaedic treatments prescribed and their costs.
- Sheetal is a 23-year-old footballer who suffered a knee injury while playing the game. So, she had to undergo a knee replacement surgery that cost her around INR 2 lakhs.
- Aakash is a 70-year-old. He, unfortunately, lost his balance and slipped while bathing. He had to undergo a hipsterism replacement surgery that cost him around INR 3 lakhs.
Will a Health Insurance Policy Cover Orthopaedic Surgery?
Orthopaedic treatment, incredibly open surgery, can be a pricey affair in India. The costs may include the treatment and related expenses (like hospitalisation, medical tests, doctor’s price, etc.). Also, some treatments may need hospitalisation for more than a day. Similar treatments could bring considerably more than a daycare procedure.
Most orthopaedic treatments are generally-invasive. Still, in severe cases, surgery must be compulsory. Therefore, the cost of availing medical care is sky high. Fortunately, orthopaedic surgery is considered a standard medical procedure in India. Hence, it is generally covered under health insurance policies. Still, this may differ from policy to policy.
More on Coverage for Orthopaedic Surgery
Orthopaedic therapy may need inserting surgical implants in the places of deformity. As mentioned before, health insurance policies generally cover Orthopaedic procedures. Also, the treatment and all the pre- and post-hospitalisation costs are covered in most cases.
A health insurance policy offers coverage and is generally subject to the sum insured limit. For instance, if the sum insured of a plan is INR 5 lakhs, you'll admit coverage for your treatment of only over INR 5 lakhs. Additional charges may have to be borne by you. Please apply to the policy wordings of a health insurance plan to find out its exact sum assured.
Staying period for Orthopaedic Surgery
The staying period refers to the time when you are not allowed to health insurance claim for ailments. This period for orthopaedic surgery might range from 1-2 years, based on the policy and the insurer. After that, you can avail of medical claims from day one itself! So, you can focus on recovering. Meanwhile, we deal with the financial implications of serving quality treatment.
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Orthopaedic surgery can rack up expenses. These costs include surgery, hospitalisation, consultation, medical tests, and more. You might have to take an alternate opinion before proceeding with the surgery, making the entire process quite expensive. Also, there are various types of surgeries that all fall within the ambit of orthopaedic surgery. Still, not all of them bring the same.
It should cover orthopaedic treatment. However, you are advised to check for the same in your policy document. If so, check the coverage limit of your health insurance policy. As orthopaedic procedures are generally ultra-expensive, a lower sum may not adequately cover your medical charges. That's why opting for a plan with a thoughtfully high sum insured is essential. This may also mean paying an advanced policy installment as well.
The two types of treatments that doctors prescribe when it comes to orthopaedic conditions are open surgery and arthroscopy. For both, health insurance policies come to one’s rescue. Also, coverage is generally offered for pre- and post-hospitalisation costs. Go through the policy wording to have a clear idea on the same.
Orthopaedic treatments are expensive. Hence, when buying health insurance, it's essential to ensure that the sum is reasonably high. Related costs like room rent, ambulance charges, discussion costs, etc., are covered to the entirety. Also, check if the policy covers daycare treatments. Generally, health insurers offer a daycare treatment cover on top of a regular health insurance plan. This cover typically covers daycare procedures that don't bear hospitalisation.
Comparing health insurance plans for orthopaedic treatment is necessary to figure out the plan offering maximum coverage for a premium you can afford. You could visit Paytm Insurance, a leading insurance marketplace allowing you to check, compare and choose the best.