• Knees play a crucial role in enabling a person to run, walk, or even sit. Without our knees, we likely wouldn’t be able to perform any basic mobility functions, not to mention engaging in adventurous activities. Nevertheless, many of us can experience knee issues, particularly as we age. Knee replacement surgery is often a highly effective solution for addressing knee-related problems.

• There has been a growing concern regarding knees. According to the Times of India, more than 2. 5 lakh people in India have knee replacement surgery [1]. The expenses for knee replacement surgery can range from Rs. 50,000 to Rs. 2 Lakh. So, shouldn’t we all have protection against such a widespread issue? This article explains how having a health insurance plan that includes knee replacement surgery coverage can be advantageous:

• What is Knee Replacement Surgery?

• Our knee joints can lead to serious complications during old age if we overlook minor yet significant factors of life when we are younger. These factors encompass obesity, a sedentary way of living, stress, and so forth. Osteoarthritis, knee injuries, long-term knee pain, and other similar issues are among the reasons an orthopedic surgeon may propose knee replacement surgery (also known as Arthroplasty).

• This procedure entails replacing the damaged bone and cartilage with an artificial joint and prosthesis. While partial knee replacement targets only the affected area, total knee replacement surgery involves replacing the entire knee with a prosthesis.

• When Do You Need Knee Replacement Surgery?

Knee replacement surgery might be required when knee pain and stiffness become overwhelming and greatly hinder your everyday activities. Generally, it’s suggested when conservative treatments, such as physical therapy, medications, and lifestyle modifications, do not yield relief. Common conditions that may necessitate surgery include severe osteoarthritis, rheumatoid arthritis, or knee injuries that cause substantial joint damage. If pain continues despite non-invasive treatments and movements become restricted—making activities like walking, climbing stairs, or even standing challenging—surgery could be an option. Ultimately, the choice depends on the severity of symptoms and how much they impede your quality of life.

• What is a Knee Replacement Surgery Cover?

A knee replacement surgery cover provides reimbursement for expenses associated with undergoing Arthroplasty. Because the definition of Arthroplasty was previously ambiguous, insurers often denied claims related to knee replacement surgery. However, this is no longer the case. Most major insurance companies now provide coverage for the costs of knee replacement surgeries in accordance with their terms and conditions. Insurance providers typically reimburse 50% of the expense on older health insurance plans. Thus, it is advisable to review your policy document to ensure maximum coverage for such medical procedures.

• Why Do You Need Health Insurance for Knee Replacement Surgeries?

Knee pain can sometimes become unbearable. In such instances, physicians recommend knee replacement surgery. Nevertheless, these medical procedures can be quite expensive, forcing us to endure the pain for as long as possible. However, with a health insurance policy, you can have the surgery done without financial worries. Therefore, when selecting a health insurance policy, ensure that it covers the costs for knee replacement surgeries. Below are the two most crucial advantages of a comprehensive health insurance policy:

1. Cashless treatment

With a comprehensive health insurance policy, you do not need to stress about gathering funds for expensive treatments. Your insurer will handle your medical expenses directly with the hospital. However, you will need to plan your surgery in advance for a smooth experience. *

2. Coverage for medical treatment

The appropriate health insurance policy will cover your pre-hospitalization and post-discharge expenses as well. This includes consultation fees, follow-ups, medical tests, etc. It will also cover inpatient hospitalization costs. Health insurance policies provide coverage for daycare surgery too. *

• Is Knee Replacement Covered by Insurance?

Yes, health insurance typically covers knee replacement surgery if it is deemed medically necessary. Most health insurance policies, including those offered by private companies and employers, cover the procedure when required due to ailments like arthritis or injury. The specifics of the coverage, including whether it includes partial or total knee replacement, may differ depending on the insurer and policy. It’s crucial to verify pre-authorization requirements, waiting periods, and policy exclusions. Moreover, some plans may also encompass rehabilitation and post-surgery care. Always check with your insurer for complete details regarding your coverage.

• Things to consider before choosing health insurance for knee replacement surgery

While health insurance is vital for everyone, you should keep certain factors in mind before selecting a health insurance plan. They are as follows:

1. Waiting period

If you are purchasing health insurance to have knee replacement surgery, verify the waiting period. Since insurers have only recently begun to regard this surgery more favorably, they might impose a waiting period of 2 to 4 years. Choose a plan with the shortest waiting time. *

2. Coverage limit

Many insurers provide only 50% coverage for Arthroplasty. Conduct thorough research and look for a plan that offers the most comprehensive benefits.

• Note: You may need to select health insurance with OPD coverage to receive benefits during subsequent follow-ups and health check-ups. *

Conclusion

Until a decade ago, health insurance companies regarded this surgery as merely cosmetic. Nevertheless, they have now recognized the necessity of knee replacement surgery. Not choosing to have this procedure means enduring severe pain whether you are walking or resting. Therefore, now that insurance providers have encompassed knee replacement surgery within comprehensive health insurance, ensure that you are protected against medical emergencies. In addition to Arthroplasty, it protects you against various other medical treatments such as cataracts, dengue, diabetes, COVID-19, and more. However, utilize health insurance premium calculators to ensure that you acquire the right insurance plan for the best offer.