GUSTAVEL ORTHOPEDICS BLOG

28Apr

Is ACL Surgery Covered by Insurance?

Knee | | Return|

The anterior cruciate ligament, or the ACL, is one of the most important ligaments in the knee. It helps keep the knee from gliding anteriorly. However, when this ligament tears, the stability of the knee is damaged. In most cases, the person will have to undergo surgery of their torn ACL. Having insurance is considered an advantage if you need ACL surgery. However, many plans vary in coverage amounts. Before you undergo this procedure, research your insurance plan and your coverage options. Here is what to expect regarding expenses and how you can manage the cost of your procedure.

The Typical Cost for an ACL Surgery

The type of plan a person has plays a huge role in the cost of your ACL surgery. The insurance company negotiates with the doctor a network rate that also impacts the cost of the procedure. If you currently have insurance, talk to your provider about your coverage of this procedure. Ask them questions regarding the information in the summary of benefits you receive through the mail or that may be viewable by logging into your insurance website's portal. If you don't, start comparing plans and their coverage information regarding surgical procedures. You also owe it to yourself to compare prices in hospitals before deciding on one. 

In addition to the procedure itself, you have to factor in other important medical choices when calculating the cost. These items include:

  • Anesthesia- Some doctors perform this surgery using anesthesia. The cost could differ for ACL surgeries without anesthesia.
  • Pre-surgery appointments- These could include diagnostic and lab tests.
  • Durable medical equipment- Crutches and braces are typically used for ACL patients.
  • Rehabilitation and physical therapy appointments- These appointments are needed in starting the recovery process.
  • Surgeons, co-surgeons, surgical assistants, doctors, the anesthesiologist.
  • Use of the hospital operating room.

These items along with other items, such as blood and plasma, help calculate the amount of your procedure.

ACL Surgery Covered by Insurance

Understand Your Insurance Network

Another good way to manage your procedure's cost is to know whether all the providers involved in your surgery are within your insurance's network. Just because your hospital is in your insurance network, doesn't mean all of your providers, such as assistant surgeons, are covered as well. Sit down with someone from the billing department to ask questions about the status of each provider involved in your surgery. Ask about the ones who are involved behind the scenes such as the radiologist reading your scans. Be sure to get written confirmation that all of your providers are in-network. If not, you may get stuck with an out-of-network bill from one of them.

Your Out-of-Network Costs

Even if your insurance does cover ACL surgery, you will still need to pay for out-of-pocket costs. The amount you pay depends on your insurance plan. Ask your insurance provider about your co-payments, deductibles, and co-insurance amounts for the surgery. If you have a health savings account or a flexible spending account, you could apply the funds from them to your payments.

Why Choose Gustavel Orthopedics for your ACL Surgery?

These are some factors that come into play whether an ACL surgery is covered by insurance or not. It depends on the type of plan and its coverage options. Gustavel Orthopedics could work with you in determining a price for your surgery. Contact us for an ACL consultation today.  

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