Is Orthopaedic Surgery Covered Under Health Insurance?
Updated On May 02, 2022
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Orthopaedic Surgery is a medical procedure for individuals suffering from bodily deformities. These could result from disease, injury or genetic causes. Orthopaedic treatment is usually administered to the musculoskeletal system of the human body. This system includes bones, ligaments, tendons, cartilage and connective tissue.
The two commonly suggested Orthopaedic treatments are open surgery and arthroscopy. In the case of open surgery, treatment may require being admitted to a hospital for a few days. However, in the case of arthroscopy, it is usually a day care procedure that spans less than 24 hours. Thus, you may not require to be admitted.
Types of Orthopaedic Surgeries
Orthopaedic treatments cater to deformities occurring in the musculoskeletal system of the body. This could include surgeries performed on the shoulder, hip, spine, ankle, wrist, knee, elbow, etc. Based on these regions, below are some of the treatments commonly prescribed.
- Shoulder Replacement Surgery
- Anterior Cruciate Ligament (ACL) Reconstruction Surgery
- Shoulder Arthroscopy
- Knee Replacement Surgery
- Spinal Surgeries
- Osteotomy
- Bone fracture repair
- Soft tissue repair
- Hip Replacement Surgery
- Knee Arthroscopy
- Joint arthroscopy
- Trigger Finger Release
- Ankle Repair
- Debridement
Does Your Health Insurance Policy Cover Orthopaedic Surgery?
Orthopaedic treatment, especially open surgery, can be an expensive affair in India. The costs may not only include the treatment itself, but also related costs (like hospitalisation, medical tests, doctor’s fee, etc). Also, some treatments may require hospitalisation for more than a day. Such treatments could cost considerably more than a day care procedure.
Most Orthopaedic treatments are usually non-invasive. However, in severe instances, surgery may be required. Thus making the cost of availing medical care sky-high. Fortunately, Orthopaedic Surgery is considered a common medical procedure in India. Hence, it is usually covered under health insurance policies. However, this may differ from policy to policy.
Coverage for Orthopaedic Surgery
As mentioned above, health insurance policies usually cover Orthopaedic procedures. Also, in most cases, the treatment cost as well as all the pre and post-hospitalisation costs are covered too. At times, Orthopaedic treatment may require inserting surgical implants in the places of deformity. This too is usually covered under most health insurance policies.
Note that the coverage offered by a health insurance policy is usually subject to the sum insured limit. For example, if the sum insured of a plan is Rs. 5 lakhs, you will receive coverage for your treatment only up to Rs. 5 lakhs. Further expenses may have to be borne by you. Refer to the policy wordings of a health insurance plan to find out its exact sum insured.
Conclusion
Due to sedentary lifestyle choices, conditions requiring Orthopaedic care have become more common. Orthopaedic Surgeries are usually expensive procedures and can cause financial hardship. Fortunately, Comprehensive Health Insurance Policies usually cover such treatments. Nonetheless, make sure to read the policy wordings of a health insurance policy thoroughly to find out the exact scope of its coverage.
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