Does Health Insurance Cover Knee Replacement?
If you are suffering from debilitating knee pain, inflammation, or deformity caused by arthritic or severely injured knees, your doctor might recommend knee replacement surgery. But knee replacement surgeries can be severely expensive.
Luckily, if you have health insurance and it’s a doctor-recommended procedure, you are likely to be covered for your knee replacement surgery. You will be required to cover the stipulated co-pay and meet all deductibles before the insurance company kicks in with its share of payments. Be sure you talk to your health insurance company before scheduling your knee replacement surgery so you know ahead of time what your costs will likely be.
What is knee replacement surgery?
Knee replacement surgery is recommended when arthritis or injury in your knee starts impacting the quality of your life. If you have trouble doing simple things such as standing up, climbing stairs, or moving, your surgeon might suggest that you undergo knee replacement surgery. In some cases, you might be asked to do a partial knee replacement.
According to WebMD, a total knee replacement is a surgical procedure that replaces the damaged joint in the knee with a prosthetic knee. The artificial joint is made of metal or plastic. The artificial joint is attached to the thigh, shin, or kneecap with special material such as bone cement. When all parts are attached, the knee regains its usual function.
The procedure is performed under general anesthesia. The patient is usually expected to stay in the hospital for three to five days for basic recovery, followed by at-home recuperation.
Most patients are also required to undergo some physiotherapy to strengthen their knee. Within six weeks, most patients regain all movement in their knees.
How much does knee replacement surgery cost?
The answer to that question depends on whether or not you have insurance.
For patients who do not have any health insurance, a total knee replacement will cost a minimum of $35,000 per knee. Since this can be prohibitive, many hospitals will offer uninsured patients some form of discount to ease the financial stress.
If you have health insurance, your insurance carrier should ordinarily cover all surgeon and anesthesiologist fees, all supplies, most medicines, facility charges, and hospital stay.
Even for patients who do carry health insurance, there are associated out-of-pocket expenses that can vary from a few hundred dollars to several thousand, which are not covered. This is dependent on the terms of your health insurance plan including your deductible, co-insurance, or co-pay.
Some additional costs of knee replacement surgery are physiotherapy sessions and safety equipment at home such as support bars in the shower, toilet seat riser, etc. You might also need to rent accommodations if you have to negotiate stairs in your house. It is important to factor these into the budget to avoid unexpected expenditures.
Patients should also keep in mind that knee replacement surgery is not permanent and the implant might need to be changed within 10 to 15 years.
When does health insurance pay for knee replacement surgery?
Health insurance companies, when ordered by your attending doctor or surgeon, usually cover knee replacement surgery. The exception to this rule is if the surgery is deemed experimental by the insurance carrier or if it has been excluded in the health insurance plan for specific procedures such as those associated with weight loss surgery.
Talk to your surgeon ahead of time and ask them to give you all the documents you will need to get preauthorization from your medical insurance company.
Additionally, Medicare covers knee replacement surgery.
What if I do not have health insurance and need knee replacement surgery?
Many patients lacking any or sufficient health insurance coverage are seeking surgical recourse overseas. With medical tourism developing rapidly and gaining acceptance within the U.S., the uninsured are heading to countries as close as Mexico and as far as India and Thailand to get comparative services at a fraction of American costs.
These medical destinations are gaining in reputation as they provide all modern procedures in well-equipped hospitals that operate at international standards. Internationally certified medical professionals provide their skills at much lower costs in these healthcare facilities.
If you have run out of all financial options, then do some research and look at international medical destinations. But before you sign on, make sure you understand all the terms and conditions of your contract. Many of these countries do not have stringent malpractice laws.
Choose a medical tourism company that offers a choice of internationally recognized hospitals and doctors. Any vendor you use should be carefully vetted.
It is important that you factor in all non-medical costs associated with any trip made overseas. These expenses will include airfare, hotel stay, food, and other incidentals such as visa fees, extended stay, etc.
It is also essential to remember that, in case you have any complications, it might not be easy to return to your surgeon.
If you are wary or disinclined to go abroad for your knee replacement surgery, you might be able to find a hospital in the U.S. that will give you a discounted rate or a payment plan option. You will need to do some research to find the correct facility.