Is Orthopedic Surgery Covered in Insurance

Orthopedic surgery is focused on our bones, like our shoulders, knees, hips, wrists, and more. Orthopedic doctors work on the bones and muscles present inside our bodies. People suffering from any type of bone-related issue can get rid of it by having orthopedic surgery, whether it is by birth, like a triggered finger, or by accident or injury.

Orthopedic surgery is not just about our bones. Issues related to ligaments, tissues, or tendons can also be cured by orthopedic surgery. There are two most common methods of performing orthopedic surgery: open surgery and arthroscopy. The most frequent orthopedic surgeries are total knee or hip replacement surgery, joint surgery, and fractures.

Here is a List of the Most Common Types of Orthopedic Surgeries

• Knee Replacement
• Revision Knee Replacement
• Hip Replacement
• Revision Hip Replacement
• Arthroscopy-Hip, Knee & Shoulder
• Spine Surgery
• Knock Knees
• Fracture Management

Does Health Insurance Cover an Orthopedic Surgery?

Orthopedic surgery is quite common in India, and most health insurance plans cover it. However, the coverage can vary depending on the policy.

Health insurance policies are detailed, so make sure to read them thoroughly before buying one. Choose a policy that matches your healthcare needs. Health insurance doesn't just cover orthopedic surgeries but also basic bone and joint issues.

Some private insurance companies make you wait 2-3 years before you can get orthopedic surgery, according to their lock-in policy. To avoid waiting for so long, go for a policy with a shorter lock-in period.

Private Health Insurance:

Private health insurance companies are operated by TPAs. A third-party administrator, or TPA, is an agency that has a license from the Insurance Regulatory and Development Authority of India (IRDAI) to help with health insurance claims and offers cashless services for an insurance company. TPAs act as middlemen between private insurance companies, policyholders, and healthcare providers.

A TPA has these important duties:

• Handling many health insurance claims efficiently.
• Providing excellent and dependable services.
• Monitoring the time it takes for cashless services and reimbursements to be completed.

Some private insurance companies that are operated by TPAs are Care Health Insurance, Niva Bupa, Star Health and Allied Insurance, HDFC ERGO General Insurance Company, New India Assurance, Bajaj Allianz, Manipal Cigna Health Insurance Company Limited, National Insurance Company, ICICI Lombard

These are simply a few names given as an example. TPAs alone handle all private insurance companies.

Health Insurance Provided by Government:

All the insurances that are provided by the government, such as CGHS, DGHS, ECHS, CAPF, NDMC, MCD, and DJB have no lock-in policy. You can get orthopedic surgery the next day after getting your health insurance.

Not all insurance schemes are offered by the Central Government. Many State Governments also offer dedicated government health insurance schemes to its employees. The health insurance policies issued by the state government also do not have a lock-in rule. You can get orthopedic surgery whenever your orthopedic surgeon recommends it.

Employees of semi-government companies like ONGC, NTPC, SAIL, IOCL, BHEL, etc. are also covered under government health insurance schemes.

Benefits of Ayushman Card in Orthopedic Surgery:

The Ayushman Bharat Yojana scheme also covers about 1,400 expensive procedures like knee replacements and skull surgery. Additionally, patients can follow up on their treatment to make sure they fully recover.

In Nutshell

You can use health insurance to cover orthopedic surgery. Private insurance might make you wait, but government insurance doesn't have that rule.

If you have either private or government health insurance, you can get knee, hip, or other orthopedic surgeries at our partner hospitals.

If you are from another state and want to use your Ayushman card for orthopedic surgery in your state, just let us know. We will assist you in getting the surgery using your Ayushman card.