What is Orthopedic Surgery? Is it Covered by Health Insurance?

The orthopedic health concerns in India are growing at a steady pace, with some of them not being limited to elderly individuals. They can now be observed across all ages, which is concerning. A sedentary lifestyle adopted by the working class has fuelled the fire. Furthermore, the COVID-19 pandemic has made it worse, as a certain set of people are still working from their homes, eliminating the mobility usually brought about by way of traveling to work. When it comes to orthopaedic treatments, minor treatments can be managed using prescription medicines, exercise, and physiotherapy treatments. But in certain severe cases, surgery is required for normal activity.

What is Orthopaedic Surgery?

Treatments required to be performed on the musculoskeletal system of the body are called orthopaedic surgeries. They are required due to an injury or other medical conditions, like congenital or acquired disorders, chronic arthritis, acute injuries to bones, ligaments, tendons, and other associated issues. The knee, hip, spine, ankle, wrist, and elbow are some common joints that require orthopaedic treatments. Arthroscopy or open surgery method are two ways of carrying out orthopaedic surgeries. Arthroscopy is a daycare procedure, whereas traditional surgeries require hospitalization for a few days. In either case, the treatment cost is steep, and a health insurance cover can help alleviate its financial burden.

Common Types of Orthopedic Surgeries

Orthopaedic surgeries are often performed on various parts of the body, including the knee, spine, hip, shoulder, ankle, wrist, and elbow. Here are some of the most common orthopaedic procedures:

1. Joint Arthroscopy
2. Joint Replacement Surgery
3. Bone Fracture Repair
4. Soft Tissue Repair
5. Osteotomy (bone realignment)
6. Spinal Fusion
7. Arthroplasty (joint reconstruction)
8. Bone Fusion
9. Debridement (removal of damaged tissue)
10. Revision Joint Surgery

While these procedures are essential for treating orthopaedic conditions, they can be quite expensive. For example, joint replacement surgery alone can cost several lakhs of rupees. Diagnostic tests like MRI and X-rays, along with regular visits to an orthopaedic specialist, add to the overall expenses. Such costs can significantly impact your finances and savings, making it important to plan ahead and explore options like health insurance or financial assistance programs to ease the burden. If you're facing an orthopaedic condition, consulting with your doctor about treatment plans and cost estimates can help you prepare better. Read More: What Is Health Insurance Card and Its Benefits?

What are the Different Costs Incurred Due to an Orthopaedic Surgery?

The costs associated with orthopaedic surgeries can get high and hence, it is best to be protected using a health insurance cover. The surgery isn’t the only cost of treatment; pre-and post-treatment expenses, consultation fees, cost of medical checkups, and other miscellaneous aspects can also contribute. In some situations, even a second opinion may be required, which further bumps up the treatment expenses. Based on the type of treatment for different joints, the cost differs. Joint replacement surgery, joint arthroscopy, bone fracture repair, soft tissue repair, spine fusion, and debridement, are some of the different treatments performed under orthopaedic surgeries. Without adequate insurance coverage, it can drain you of your hard-earned savings and may even pave the way for a debt trap. To select a suitable insurance coverage, if you have a family history of orthopaedic ailments, it is best to use a health insurance premium calculator. This nifty tool can be used for comparing different policies and knowing about the insurance premiums basis the sum insured. *Standard T&C Apply

Is Orthopaedic Surgery Covered by Health Insurance?

Depending on the type of insurance plan, orthopaedic surgeries are covered by health insurance policies. Most insurers include the hospitalization in the scope. However, pre-and post-treatment coverage is what you need to keep an eye for. Some insurance policies even include compensation for surgical appliances, cost of implants, doctor’s fees, room rent charges, and similar expenses. Since most orthopaedic surgeries recommend physiotherapy sessions after the surgery, it is best to look for a plan that includes such post-treatment costs. Health insurance policies not only cover instances of hospitalization but also arthroscopy, which is a daycare procedure. The extent of coverage of every insurance cover depends on its policy terms. Thus, having an informed knowledge of these terms before making the payment is essential.

Orthopaedic Surgery Coverage

Health insurance plans generally provide a range of coverage options for orthopedic surgeries, helping patients access necessary treatments without facing financial burdens. Below are some typical coverage features:

1. Pre-Hospitalization Expenses: Consultations, tests, and imaging.
2. Hospitalization: Room charges, surgery costs, and nursing care.
3. Post-Hospitalization: Rehabilitation, physiotherapy, and follow-ups.
4. Prosthetics and Implants: Artificial joints or devices used during surgery.

Orthopedic Surgery Waiting Period

The waiting period in a health insurance plan refers to the duration after purchasing the policy during which you cannot file a claim. For example, the waiting period for orthopedic surgeries typically ranges from 1 to 2 years. For individuals with pre-existing medical conditions, this period can be significantly longer. However, the specific terms and conditions vary depending on the insurer. With the Bajaj Allianz Health Insurance Policy, there is no waiting period for pre-existing conditions, provided they are disclosed at the time of policy purchase. This means you can start making medical claims from day one, allowing you to focus on your recovery while we handle the financial burden of quality healthcare.

Conclusion

Orthopaedic conditions can lead to serious consequences if not addressed promptly. In some cases, orthopaedic surgery may be necessary to treat these conditions. To safeguard your savings from the costs of orthopaedic surgery, it's important to purchase a health insurance policy that covers both open surgeries and day care procedures. Be sure to carefully review the terms and conditions of your policy before making a claim. Read More: Hospital Daily Cash Allowance in Health Insurance

FAQs

1.What are the Orthopaedic treatment costs covered under a health insurance policy?

Health insurance typically covers expenses related to hospitalization, surgeries, pre-and post-hospitalization costs, physiotherapy, and diagnostics for conditions like fractures, arthritis, and joint replacements. Coverage may vary based on the insurer and policy.

2. Is the medical cover offered by a health insurance plan adequate for covering Orthopaedic treatments?

Health insurance plans often provide adequate coverage for most orthopaedic treatments, including surgeries and hospital stays. However, policyholders should verify the specific terms and limits with their insurer to ensure full coverage.

3. In the context of Orthopaedic treatment expenses, what are the coverages to look for when buying a health insurance plan?

When purchasing health insurance, look for coverage for inpatient hospitalization, pre/post-treatment expenses, rehabilitation, joint replacement surgeries, and any co-payments or sub-limits for orthopaedic conditions.

4. What benefit does a health insurance plan provide for individuals suffering from conditions requiring Orthopaedic treatment?

Health insurance can significantly reduce the financial burden of orthopaedic treatments by covering surgery costs, rehabilitation, hospitalization, and medication. It also provides access to high-quality care and reduces out-of-pocket expenses. *Standard T&C Apply Among the various benefits of health insurance plans, coverage for orthopaedic treatments is one of them, and for those seeking coverage, is a blessing. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read the sales brochure/policy wording carefully before concluding a sale.