Guide to Smart Health Insurance Planning for Knee Replacement Surgery

Posted on: Apr 3, 2024 | 3 mins | Written by: HDFC ERGO Team

Guide to Smart Health Insurance Planning for Knee Replacement Surgery

The most vital organ that keeps you mobile is your knees. The knees help a person to run, sit, and walk. Without them, we can’t do basic mobility operations or adventure. But with age, we tend to have a lot of troubles related to our knees. So, knee replacement surgery is the best way to cure knee pain. In India, knee concerns have rapidly increased, and so many older people undergo knee replacement surgery. On average, the expenses for a knee replacement surgery range between 50 thousand to 2 lakh rupees. And every year, around 2.5 lakh people undergo this surgery. Therefore, this article expounds on whether health insurance covers knee replacement surgery and choosing health insurance wisely.

Understanding Knee Replacement Surgery:

Before understanding whether health insurance for “knee replacement surgery”, we must know briefly about knee replacement surgery. With age, our bodies undergo a lot of changes and tend to tear. Similarly, our knee joints undergo pressure due to a sedentary lifestyle, unwanted stress, and changing habits. This, with time, will lead to unbearable pain because of the damaged cartilage.

Knee replacement surgery is broadly classified into two categories.

• Total Knee Replacement Surgery: All three areas of the knee, like the lateral (lateral), medial (inside), and patellofemoral (under the kneecap), are damaged. This type of knee replacement is the most common among the elderly population.

• Partial Knee Replacement Surgery: Only one or two areas of the knee are damaged and need surgery. Among the young adults injured or met with any serious trauma, undergo this treatment.

Knee replacement surgery falls under the orthopaedic category, a way to fix damaged bones and ligament tears around the human knee. The surgery replaces damaged ligaments and bones with artificial sub-parts or prosthetics to restore regular mobility functions. Knee replacement surgery is expensive and can put a hole in your pocket. Hence, it is recommended that a strong financial tool be used to recover expenses.

Knee replacement surgeries are non-invasive, and the risks involved are low. It takes 18 months to recover after the operation is successfully executed. Also, straining the knees is highly restricted during the recovery tenure. With gradual steps and regular checks, one can resume mobility activities.

Health Insurance Coverage for Knee Replacement Surgery:

The knee replacement surgery cover refunds all the expenses related to the Arthroplasty or knee replacement surgery. Initially, the definition of this surgery was ambiguous, so many insurance agencies rejected the claims against knee replacement surgery. However, with time and consideration of the number of cases undergoing knee replacement surgery, leading insurers refund and cover the costs of replacement surgeries complying with their terms. On the old health insurance policies, 50 per cent reimbursement is done. Therefore, opting for the latest policy document will help you get maximum medical coverage benefits.

One must check two factors before choosing health insurance for knee replacement surgery. One is the waiting period, and the other is the coverage limit. The waiting period to claim knee replacement surgery medical expenses can range between 2 to 4 years. Always opt for the shortest waiting period policy. Another essential factor is the coverage limit, as many insurers offer up to 50% maximum coverage.

The Cost of Knee Replacement Surgery:

The expenses incurred during a knee replacement surgery are not limited to operation costs, but there are various other expenses as listed below:

• Routine check-ups and tests

• Ambulance costs

• Hospitalisation costs

• Physiotherapy costs

• Medication costs

• Consultation fees

The exhaustive expenses for a knee replacement surgery in India can go from 2 lakh to 3 lakh rupees. Hence, purchasing appropriate health insurance for a knee replacement plan that extends and covers knee replacement surgeries is essential to save on personal expenses.

Navigating Insurance Coverage:

The inclusions under the knee replacement surgery are as follows: Unlike the previous decade when insurers considered knee replacement surgery cosmetic. Many top insurance policy providers offer coverage for knee replacement under a health insurance policy. The standard inclusions are.

• Cashless facilities: You don’t have to rethink when choosing a high-ticket treatment for surgeries like knee replacement. You can only book an appointment with the insurance provider’s network hospital and seek seamless facilities.

The insurer will settle the bills; you do not have to spend your money.

• Medical expenses coverages: All the medical costs like ambulance charges, doctor consultation fees,pre-checks, and hospitalisation room fares are covered under a single health insurance policy.

Appealing Insurance Denials:

There are a few ways in which your health insurance for knee replacement policy claims will get rejected.

• If the policy subscriber denies to inform the issuer

• Claims within the locking period of the policy

• The health issues are niche and excluded from the policy

• Incorrect information is filled in the application form

• The claim sum exceeds the amount defined in the health insurance

Conclusions

We cannot predict upcoming health issues and diseases with the changing environment and uncertainty. Considering the growing healthcare expenditures, opting for a financial safety plan like a health insurance policy is necessary. Now, health insurance companies understand that knee replacement surgery is no longer a cosmetic surgery but a relief from excruciating knee pain. Comprehensive health insurance covers knee replacement surgery and refunds all expenses for homoeopathy or medications. Along with knee replacement surgery or Arthroplasty, the comprehensive health insurance policy covers all the costs related to multiple medical emergencies like COVID-19, dengue, diabetes, and many more.

Disclaimer The above information is for illustrative purposes only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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