Covering the Cost of Joint Replacement and Other Surgeries | Checklist

If you’re considering joint replacement or other orthopedic surgeries, one of the most basic questions you’ll have is whether the cost of surgery and after-care is covered by insurance. Understanding your health plan coverage will keep you from having any unwanted surprises. This checklist can help guide your conversations with your insurances carrier and your doctors.

• Do you understand what your health plan covers for surgery – both physician fees and facility fees (hospital or surgery center)?
• Do you need a referral from your primary care physician before seeing an orthopedic specialist?
• Does the surgeon you are considering accept your specific health plan and product? (Be sure to ask this question when making your first appointment.)
• Does the hospital or surgery center he/she is recommending accept your specific health plan and product?
• Does your plan cover all needed services while in the hospital, including physical therapy?
• Does your plan cover prescribed medical equipment like a walker, crutches, support pillows, slings, etc. provided in the hospital?
• Does your plan cover medical equipment you might purchase before or after surgery, for use at home? This includes things like bedside commodes, grab bars, shower transfer benches, etc.
• Does your plan cover physical and/or occupational therapy services you might receive at home, after you leave the hospital? If so, for how long? Are there limits on your coverage?
• Does your plan cover discharge to a rehabilitation facility, if you do not have help at home from a family member or friend? If so, for how long? Are there limits on your coverage?
• Does your plan cover at-home visits by care providers, if you do not have help at home from a family member or friend? These would not be physical therapists, but home health aides to assist with bathing, dressing, meals, etc.