Is ACL surgery covered by insurance?

Is ACL surgery covered by insurance?

yes, ACL surgery It is basically covered by insurance, but a doctor’s approval is required.If your doctor determines that your surgery is medically necessary for your treatment Torn ACLIt is covered by most insurances.

If you have a new policy, you should be aware of the waiting period. The waiting period is the period during which claims cannot be made. It begins on the date the policy is issued and typically lasts 60-90 days for ACL surgery.

If you already have insurance, talk to your provider about coverage. Ask clearly about approved plans, what costs are covered, when payments will be made, etc. If you don’t have a plan, browse the different plans available, compare them and choose. Make sure you have prior approval for the surgery.

However, many plans have different coverage amounts. Research your insurance plan and coverage options before taking this step. Read ahead to learn more about ACL surgery and its insurance coverage.

What is ACL reconstruction surgery?

ACL reconstructive surgery, or knee arthroscopy, is a minimally invasive procedure that repairs or replaces torn ligaments with grafts. Graft replacement is generally considered the best treatment for severe ACL tears.

The anterior cruciate ligament, or ACL, is one of the most important parts of the knee. Supports the knee joint and prevents the knee from slipping forward. But when the knee is stretched beyond its limit, the ligaments tear. Mild tears can be managed with physical therapy. But the only way to treat severe tears It is due to surgery. A good insurance policy is your best bet to complete your treatment without breaking the bank.

Also read- Recovery Timeline and Tips for ACL Reconstruction Surgery

How does insurance help with ACL reconstruction surgery?

The costs during ACL reconstruction surgery that are generally covered by all insurances are:

  • Room and operating room rent
  • Nursing care costs during surgery
  • ICU admission fee/hospitalization fee
  • Fees charged by specialists, surgeons, consultants and anesthesiologists during surgery
  • Medicines and medical expenses such as anesthesia, blood, oxygen, prostheses, and grafts required during surgery
  • Hospitalization expenses other than the above

High-premium insurance covers not only the cost of surgery, but also pre-hospital costs (about 30 days before surgery) and post-surgery costs (about 60 days after surgery). This includes costs for diagnostic tests, medications, assistive devices, physical therapy, etc.

Also, if insurance is applied, you can receive surgery cashless. This means that your hospital bill is covered by your insurance and you don’t have to worry about paying the hospital during your surgery.

How much does ACL reconstruction surgery cost?

average cost of ACL surgery Range from Rupees. 1,40,000 Rs. 2,00,000 including surgical costs, pre-hospital costs and post-hospital costs. The cost of surgery generally depends on the following factors:

  • degree of damage
  • Graft selection
  • hospitalization fee
  • insurance coverage
  • Surgeon experience and fees
  • Observation and rehabilitation required
  • Anesthesia and anesthesiologist costs
  • Aids (crutches, braces, etc.) and medications needed after surgery
  • Patient’s pre-existing condition and complications during surgery

Check your surgery copays, deductibles, and co-insurance amounts. With prior approval, funds can be applied to payments from your Health Savings Account or Flexible Spending Account.

Also read- What to do for knee ligament and meniscus injuries

What is the out-of-pocket cost for ACL surgery?

In general, the out-of-pocket cost for ACL surgery depends on your insurance coverage: type of insurance, premiums, deductibles, etc. Most insurances partially cover surgery. So even though insurance covers his ACL surgery, he still has to pay a portion of the total surgery cost himself.

Please ask your insurance company about the cost of surgery (copayment, deductible, co-insurance). If you have too much money in your Flexible Spending Account (FSA), Health Savings Account (HAS), and Health Reimbursement Account (HRA) to pay at once, apply for Out-of-Pocket Expenses.

What is the insurance approval process like?

This process may sound daunting, but it is relatively simple and straightforward. Along with your insurance policy, you will be issued an insurance card with all the details. You can forward your card details to your billing address or contact your insurance company for approval.

pristine care Insurance approval made easy for all patients. With Pristyn Care, patients simply forward their insurance details to their care coordinator and wait for approval. The rest of the process is handled by the insurance team themselves. Is ACL surgery covered by insurance?

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