Does Health Insurance Cover Orthopedic Surgeries in India?

Wondering about whether health insurance covers orthopedic surgery in India? This is a common question for many people today, especially those who live sedentary lifestyles and are susceptible towards various diseases including bone infections and ailments. Minor orthopedic treatments may involve exercises, suitable medication and even physiotherapy, while severe conditions may necessitate surgeries. 

What is Orthopedic Surgery?

Orthopedic surgery is a specific medical treatment which is done for the body’s musculoskeletal system in case of any trauma, injury or other health conditions. It is performed for the treatment of orthopedic ailments due to acquired or congenital disorders, severe bone injuries, arthritis of a chronic nature, and injuries to the tendons, ligaments, bones and linked soft tissues. 

An Insight into Orthopedic Surgery

Before you get into the intricacies of the bone fracture surgery cost in India or scoliosis surgery cost in India, depending on the treatments that you are concerned about, it is wise to learn a little more about surgeries in this domain of medical expertise. 

These surgeries may be performed via arthroscopy or open-surgery methods. In the latter scenario, patients will have to be admitted for 2-3 days in hospitals. The former is done in the form of daycare treatment which requires hospitalization for less than 24 hours in most cases. Patients can usually return home on the same day itself. 

10 Different Types of Orthopedic Surgeries

Some of the commonest types include the following: 

1. Joint replacement surgery
2. Joint arthroscopy
3. Osteotomy
4. Bone fracture repairs
5. Spine fusion
6. Soft tissue repairs
7. Arthroplasty
8. Debridement
9. Fusion of bones
10. Revision joint surgery

If there is any specific health condition that a patient is suffering from and requires surgery to fix it, then it may lead to higher costs in many cases. These are costly surgeries as you will find out when you enquire about the hand surgery cost in India or even the wrist surgery cost in India. You will also see how the shoulder surgery cost in India or the ankle surgery cost in India is quite exorbitant to say the least. Joint replacements may cost up to Rs. 2 lakh or more in most cases. Diagnostic procedures like X-rays or MRIs are also costly and frequent orthopedic consultations may also be expensive.

Is Health Insurance Coverage Available for these Surgeries? 

Orthopedic surgeries are always covered by health insurance plans in the country. Almost all plans will have financial coverage for the costs of surgery, hospitalization, room rent, fees of doctors, operation theatre costs, surgical appliance costs, fees of anesthetists, nursing costs, surgical implant costs and more such categories. Several health insurance policies will also provide coverage for post and pre-hospitalization expenditure including physiotherapy costs. Even if the surgery in question functions like a daycare treatment, you can still get the insurance company to cover the costs if you have your health insurance policy with coverage for these types of treatments. This is often contained in several health insurance policies. You should carefully whether the policy offers coverage for these daycare procedures. 

Health insurance policies may also offer coverage for orthopedic surgery costs, either fully or partly. Yet, the coverage scope is fully dependent upon the policy’s terms and conditions. Hence, you should always enquire with your health insurance company once your surgery is scheduled to take place. This will help you get an idea of the extent of coverage and how much you may have to pay from your own pocket if there are any exclusions. 

Waiting Periods for these Surgeries Under Health Insurance Plans

Even though a majority of health insurance policies in the country offer adequate coverage for orthopedic treatments/surgeries, some treatments may get coverage after a certain waiting period only. Insurance players usually offer coverage for orthopedic processes such as arthritis and joint replacement surgeries after an initial waiting period that is one or two years in most cases. This means that patients cannot raise their medical claims for such treatments before the passing of this period. However, daycare treatments are separately covered and do not have waiting periods in most scenarios. 

You should also keep in mind when you were diagnosed first with any specific orthopedic ailment/condition. If this was before purchasing the health insurance policy, then the company will take it as a pre-existing ailment. A majority of health insurance plans offer coverage for pre-existing diseases after waiting periods hovering between two and four years on average. Thus, if you were suffering from any pre-existing orthopedic illness, then you cannot raise any such claim for the surgery until the waiting period is completed. 

Health Insurance is the Savior in Such Cases

Orthopedic conditions require swift treatment and may otherwise have serious complications. You may need surgeries or daycare treatments, depending on the condition and its severity. The best way to get financial coverage for these treatments is to choose cashless/reimbursement health insurance claims. Before choosing any health insurance policy, check the terms and conditions carefully. If you get the right health insurance plan, then you will not have to worry about the financial impact of these surgeries and the quality of healthcare treatments. You can get the costs covered by your policy without dipping into your savings or jeopardizing your family finances.