Does Health Insurance Cover Spinal Fusion?

The spinal cord is the main support of your body, that helps you maintain an upright posture and perform activities like sitting, walking, bending, and twisting. However, if you experience a spinal injury due to an accident or a medical condition, you may suffer from chronic back pain and difficulty in movement that can persist for several months. Back pain is a common issue faced by many people that affects their daily lives. But if it lasts for more than three months even after taking medicines and physiotherapy, your doctor may advise a spinal fusion surgery depending on your condition. Now the question arises, ‘does insurance cover spinal fusion surgery?’ In this blog, you will learn about spinal fusion and is spinal fusion covered by insurance. Let’s begin!

What is Spinal Fusion Surgery?

A spinal fusion surgery is a procedure commonly performed to treat chronic back pain resulting from a variety of spinal cord issues like deformities, instability, injuries, etc. In this procedure, two or more vertebrae are joined or fused to form a single unit. The purpose of spinal fusion is to prevent movement between the two vertebrae, which helps provide stability and reduce back pain due to spine conditions.

It is like a welding process in which a bone or a similar material is used in the space between the two spinal bones. The bone graft holds the two bones with the help of hardware such as a metal sheet, a rod and a screw. This graft is fused with the spinal bones and will heal over some time.

When is Spinal Fusion Surgery Needed?

A spinal fusion surgery is used to treat the following spine conditions:

• Slip or ruptured disc
• Congenital spine issues
• Infection in spine
• Compressed nerves in the neck and lower back
• Scoliosis
• Spondylosis
• Stenosis
• Tumours in and around the spine
• Spine fractures

Types of Spinal Fusion Surgeries

There are different types of spinal fusion procedures that use different techniques depending on the level of the affected spine and the location of the compressed nerves. Most of these procedures can be performed with minimal invasion using advanced image guidance systems. Some common fusion techniques for different levels of spines are:

1. Cervical Spine

Anterior cervical corpectomy and fusion

• Anterior cervical discectomy and fusion
• Posterior cervical decompression and fusion

2. Thoracic Spine

• Posterior instrumentation and fusion
• Anterior decompression and fusion

3. Lumbar Spine

• Interbody fusion (Anterior and posterior)
• Posterolateral fusion

Does Health Insurance Cover Spinal Fusion Surgery?

Yes, most health insurance providers cover different types of spinal surgeries subject to waiting periods and terms and conditions of the policy. However, the coverage is provided for medically necessary spinal fusion procedures depending on the health condition of the policyholder. Any spinal injury caused by an accident or a medical condition is covered up to the limit specified in the policy.

*Note that spinal degeneration caused by congenital conditions is not covered under health insurance.

What are the Costs of Spinal Fusion Surgery?

There are many factors that influence the cost of spinal fusion surgery:

• The severity of the spinal condition: determines the need for a complex and long surgical procedure. A complex procedure will require specialised equipment and expert surgeons to perform the surgery thus escalating the costs.
• The type of hospital and location: also play a role in determining the cost of the surgery. Treatment at the top hospital in a tier 1 city will increase your overhead expenses leading to high costs.
• Type of spinal fusion surgery: like a minimally invasive procedure will cost more due to the involvement of advanced technology and specialist surgeons.
• Pre-existing health conditions: also add to the cost as they may require additional medical attention, diagnostic tests and longer hospital stays.
• Post-operative recovery: including the cost associated with rehabilitation, and follow-up consultations also adds to the cost of spinal fusion surgery.

Understanding these factors along with the insurance coverage helps a patient in making an informed decision. Hence, investing in a comprehensive health insurance plan helps you access the best medical care without worrying about medical costs.

>> Also Read: How to Make Health Insurance Premium Payment Online

Why Choose Care Health Insurance?

If the question ‘does mediclaim cover spinal fusion surgery’ is bothering you, know that Care health insurance provides a wide range of health insurance plans to suit a variety of healthcare needs. Our Operation Mediclaim is an indemnity-based plan that only covers different types of surgeries specified in the policy. It provides coverage for a wide range of orthopaedic and neurological surgeries including spine surgery subject to the terms and conditions of the policy. The plan also provides coverage for pre and post-hospitalisation expenses that can help you manage recovery expenses after the surgery.

Another plan that you can consider is Care Secure which is a personal accident policy that covers the treatment costs of injuries resulting from an accident.

Take Away!

Maintaining a healthy body and weight can help you prevent spine-related injuries or medical issues. However, sometimes due to unforeseen events pain and injuries are inevitable. In such a situation having suitable and adequate health insurance coverage is the only way to keep you financially secure. Maintain a portfolio of different types of health insurance plans to provide you with extensive health insurance coverage.

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.