Is Knee Arthroscopy covered under insurance?

Conditions for which Knee Arthroscopy is Recommended

Knee arthroscopy can be recommended by doctors for the following conditions:

• Meniscus Tears: This condition occurs when the rubbery disc that provides cushioning in your knee gets torn due to injury or wear and tear. An arthroscopy can repair or remove the damaged tissue.
• Ligament Tears: Ligaments such as the ACL (anterior cruciate ligament) or PCL (posterior cruciate ligament) can tear due to traumatic injuries. In these cases, arthroscopic surgery may be recommended for repair.
• Cartilage Damage: Sometimes cartilage within the knee joint can become damaged causing significant pain. Arthroscopy is an effective way to address this issue.
• Synovitis: This is inflammation of the knee joint lining, which can cause severe discomfort. Knee arthroscopy can be used to provide relief.
• Loose Bodies: In some instances, loose fragments of bone or cartilage can get lodged in the knee, which may need removal through arthroscopy.

Cost Covered Under Health Insurance & Mediclaim for Knee Arthroscopy

Health insurance and Mediclaim policies in India usually provide coverage for knee arthroscopy because it is deemed medically necessary. The cost of this surgical procedure can vary but is generally lower than knee replacement surgery. Medically necessary surgeries that can be covered under insurance could include conditions like a torn meniscus or cartilage damage. Here’s a general overview of the costs that may be covered:

• Room and boarding charges: The cost of your hospital room during your stay, including nursing care, meals, and other necessary facilities may be covered under insurance for your policy.
• Surgery expenses: The actual cost of knee arthroscopy is often covered. This includes surgeon’s fees, anaesthesia costs, and other associated OT charges.
• Medical expenses: Costs related to medical tests, medications, and physiotherapy post-surgery could also be covered under insurance for you.
• Pre-existing conditions: If you have a pre-existing condition related to your knee, there may be exclusions or waiting periods before coverage kicks in.

It’s essential to remember that every insurance policy varies. Some may cover entire costs while others may only partially cover the costs, after taking into account deductibles and copays. Always review your policy document carefully for specific coverage details. Always review your policy or use the help of an expert to understand what is covered under insurance for you.

Questions to Ask Your Insurance Provider About Knee Arthroscopy

Before you opt for surgery, it’s crucial to clear any queries with your insurance provider. Here are some questions to get you started:

• Does my insurance policy cover knee arthroscopy surgery?
• Are there any exclusions or limits on what’s covered under insurance for me?
• What is the deductible, copay, or coinsurance I’ll need to pay?
• Do I need pre-authorisation from the insurance company before surgery?
• Are there network requirements for hospitals or surgeons?
• Is post-operation physical therapy covered under insurance?
• Are follow-up visits included in my insurance coverage?
• What’s the process of claim settlement in case of knee arthroscopy?
• How long is the waiting period for pre-existing conditions?
• What happens if my insurance claim is denied?

Why Choose Pristyn Care for Knee Arthroscopy

Pristyn Care is a trusted healthcare provider that offers comprehensive care for knee arthroscopy in India. Here’s why you should consider choosing Pristyn:

• It provides access to a network of top orthopaedic surgeons and JCI/NABH accredited hospitals.
• You receive personalised care and 24/7 support.
• You also get assistance with visa requirements and insurance paperwork.

Whether knee arthroscopy is covered under insurance or not at Pristyn Care, they provide a host of other benefits, including cashless payment options and an overall seamless healthcare experience.

However, to ensure you have a clear understanding of your insurance coverage for knee arthroscopy, it’s best to consult with a healthcare provider like Pristyn Care and directly check with your insurance company. They can guide you through the process, navigate costs, and provide you with the best coverage options for your knee arthroscopy surgery in India.