Does Health Insurance Cover for Total Knee Replacement Surgery?

Knee replacement surgery, commonly known as arthroplasty, is a procedure that replaces the knee joint. It helps reduce discomfort and restore function in damaged joints. An orthopaedic surgeon evaluates the knee's mobility, stability, and strength to see if a knee replacement is correct for you. X-rays aid in the assessment of the damage. The procedure includes cutting the diseased cartilage and bone from your thigh bone, kneecap, and shinbone and replacing it with an artificial joint (prosthesis) consisting of metal alloys, high-grade resins, and polymers.

Your overall health and other pre-existing conditions affecting your knees affect the cost of your surgery. The procedure can cost you anywhere between ₹50,000 to ₹2 lakhs as these prosthetics are expensive and often need to be imported from other countries. Also, there are external costs that affect the expenses, such as physiotherapy, aftercare expenses, follow-up fees etc.

A health insurance policy or group health plan can effectively assist in meeting these heavy expenses. Thus, it's important to understand the coverage of total knee replacement procedures under healthcare insurance. This blog discusses the same. But first, let's look at the steps you can take to avoid this procedure in the first place.

How Tips to Avoid Knee Replacement

Total knee replacement can be necessary for people with severe knee pain and mobility problems. While it can be an effective solution to alleviate pain and improve quality of life, the cost of the procedure can be significant. You can consider the following tips to avoid this expensive procedure:

Lose Weight to Reduce Knee Joint Stress

When you walk or run, the majority of your weight is supported by your knees. If you're overweight, you're putting unnecessary strain on your knees, which can lead to more injury. If you're attempting to lose weight, look for sports that aren't weight-bearing, such as swimming, so you may drop weight without further harming your knees.

Medications and Supplements

Supplements like glucosamine and chondroitin have been shown to help with osteoarthritis. If alternative therapies fail to relieve severe pain, opioid analgesics may be prescribed. These non-surgical treatments are contingent on the patient's willingness to undertake behavioral changes such as weight loss and exercise.

Strengthen Your Leg Muscles

When it comes to preventing a knee replacement, your thigh muscles are very helpful. If your muscles are weak and your knee discomfort is severe, a physical therapist can teach you exercises to strengthen your thigh muscles. When your thigh muscles are strong enough, your knees will hurt less when you try to walk or run.

A Knee Unloader Brace

Unloading the painful side of the knee and shifting the stressors to the side with the least amount of arthritis is the goal of an unloader brace. Patients with osteoarthritis of the knee can benefit greatly from the usage of these braces. 

Policy Coverage for Total Knee Replacement Surgery

Earlier, this surgery was classified as a cosmetic treatment or an implant and was thus excluded from medical policies. But, in present times, most health plans cover total knee replacement surgery.

The amount of coverage, however, can vary depending on the type of plan and the insurance company. Some plans may cover only a portion of the costs, while others may cover the entire procedure. This depends on the type of health plan, the specific insurance company, and the specific policy. Some policies may have exclusions or limitations for certain procedures, which may include knee replacement surgery. It is thus important to review the policy documents carefully and speak with the insurance company to understand the coverage provided. Patients should also speak with their healthcare provider to obtain a pre-authorisation before undergoing the procedure to ensure that it is covered by their insurance plan.

Understanding health insurance coverage for this surgery can help patients make informed decisions about their healthcare. By doing so, patients can avoid unexpected out-of-pocket costs and ensure that they receive the care they need to improve their life. Make sure you compare health policies online and check over all of the perks completely so you can invest in solid knee replacement coverage in your plan.

Parting Thoughts

In addition to arranging for adequate policy cover, you must also arrange for post-surgery recovery beforehand. For instance, you may require crutches or a walker for several weeks following the treatment, so make sure that you have these before your surgery. Ascertain that you have transportation home from the hospital. If you live alone, your surgeon's office or the hospital discharge planner may be able to recommend a temporary caregiver.

Additionally, create a living area on one level, as ascending stairs might be challenging after the surgery. Also, consider installing a sturdy railing or safety bars in your shower and handrails for stairwells. Invest in a solid chair with a firm seat cushion and back, as well as a footstool to raise your leg. These steps, plus the right insurance policy, will make your recovery simpler.