Does Health Insurance Cover Hip Replacement?


Does Health Insurance Cover Hip Replacement?

If you have been experiencing persistent pain in your hip that is severely impacting your mobility and ability to perform daily activities then it is a serious matter! If conventional treatments like medication and therapy have failed to provide any relief, hip replacement surgery may be a viable treatment option for you. However, if the cost of hip replacement surgery is your biggest concern and the question ‘does health insurance cover hip replacement surgery’ is bothering you, keep reading to learn everything about hip replacement and the coverage for the cost of hip replacement surgery with mediclaim.

What is Hip Replacement?

Hip replacement or hip arthroplasty is a surgical procedure to replace or remove the damaged bone or cartilage of the hip. It is replaced with prosthetics or implants such as a metal stem. The hip joint consists of a ball and a socket that enables free movement. A hip replacement surgery involves the replacement of one or both of these parts of the hip joint.

When Do You Need Hip Replacement?

Some certain signs or symptoms indicate that you need hip replacement surgery. These signs along with some diagnostic tests can help you decide whether you should opt for a hip replacement surgery or not.

If You Experience Unbearable Pain

When a damaged hip joint causes unbearable pain in between your hip and knee, and you have discomfort in walking, bending or climbing, you walk with a limp, painkillers don’t help much and no treatment is helping. It is an indication that you might need hip replacement surgery.

If Your Mobility and Daily Routine is Affected

A damaged hip joint is affecting your mobility. You are not able to do your daily tasks such as wearing socks and shoes, standing or walking due to the inability to balance your weight.

If Stiffness in Hips is Persistent

If you are experiencing chronic stiffness in your hips and cannot lift your legs due to an injury, consult your doctor without any delay. Chronic stiffness that does not go away is a clear sign of hip joint damage.

If Conventional Treatments are Not Helping

You have tried all treatment options like medication, physiotherapy, acupuncture and steroid injections but nothing can provide any relief from the pain. If these treatments are ineffective, hip replacement surgery is your only option to improve hip joint function.

Diagnostic Tests Indicate Joint Damage

If your diagnostic tests indicate joint damage, your doctor may advise hip replacement. For instance, your X-ray image indicates a deformity in the hip joint or your MRI scan shows the deteriorating condition of the soft tissues and bone of your hip.

What Causes Damage to Hip Joint?

Common causes of damage to the hip joint include:

  • Osteonecrosis, caused by an injury such as a fracture or trauma, may lead to damage in the hip joint because of the death of cells due to loss of blood supply to the bone. 
  • Osteoarthritis causes wear and tear of the cartilage cushion of the hip bones due to ageing.
  • Rheumatoid arthritis causes inflammation in the hip joint which results in stiffness and pain. It may slowly affect movement because of the damage to the cartilage.
  • Posttraumatic arthritis is caused by an injury to the hip bone such as a fracture.
  • Hip disease in childhood due to which the hip does not have normal growth which causes arthritis in older age.

Does Mediclaim Cover Hip Replacement Surgery?

Yes, both mediclaim and health insurance plans cover the cost of hip replacement surgery. However, the coverage is provided as per the terms and conditions of your health insurance plan and is subject to the waiting period specified in the policy. Hence, it is recommended to select a plan that offers comprehensive coverage against a wide range of medical expenses.

What are the Expenses Covered by Mediclaim for Hip Replacement Surgery?

How much does mediclaim for hip replacement offer- will depend on the expenses covered under your mediclaim and the co-pay opted by you.Every health insurance plan offers different coverage but some common expenses covered by most health insurance plans include:

  • Inpatient care including room rent, nurse charges, OT charges, etc.
  • Expenses related to medical supplies during hospitalisation 
  • Doctor’s consultation fees
  • Cost of prosthetics or implants
  • Diagnostic tests and prescription medicines
  • Pre and post-hospitalisation expenses
  • Ambulance charges as specified in the policy

In addition to these expenses, the policyholder has to pay a portion of the medical costs as co-payment. Opting for a co-payment helps in reducing the premium amount. However, it is recommended to select a plan with zero co-payment so that you don’t have to pay any medical costs from your pocket.

>> Also Read: Does Your Health Insurance Cover the Surgery Cost?

How Much does Mediclaim Cover for Hip Replacement?

The scope of coverage may differ from insurer to insurer. For example Operation Mediclaim offered by Care Health Insurance covers all major surgical procedures with sum insured options up to ₹1 crores. It covers all defined surgeries on an indemnity basis. The plan is customisable with many optional benefits such as international second opinion, air ambulance cover, room rent modification, additional sum insured, etc.

Ensure Complete Coverage for Hip Replacement!

Now that you know the answer to the question ‘does health insurance pay for hip replacement surgery’ make sure that you understand the terms and conditions of your health insurance coverage before filing any claim so that your claim is not rejected. For any surgery related coverage, you can consider our Operation Mediclaim policy that comes with extensive sum insured options ranging from 10 lakh to 1 cr. Analyse your requirements, connect with our experts and buy accordingly.

Disclaimer: The above information is for reference purposes only. Kindly consult your general physician for verified medical advice. The health insurance benefits are subject to policy terms and conditions. Refer to your policy documents for more information.

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