Orange County Orthopedics

Is ACL Reconstruction Surgery Covered By Insurance

arthritis-pain-caThe anterior cruciate ligament (ACL) in the knee may tear after twisting, falling, or trauma. In some cases, ACL tears can be managed with non-surgical methods. However, moderate to severe tears may require surgical reconstruction, especially if the patient is an athlete who requires full use of the knee. Fortunately, ACL reconstruction surgery is covered by insurance.

When ACL Surgery is Necessary

Ligaments are poorly vascularized, which means that they do not have a good blood supply. This makes it hard for them to heal from a tear, and ligaments heal slowly if at all.

It is often possible to control the symptoms of pain and instability associated with mild to moderate tears using non-surgical methods, especially in patients who do not do physically strenuous activities. For example, physical therapy strengthens the muscles that support the knee.

On the other hand, moderate to severe tears may need surgical reconstruction because they cannot heal on their own and may cause severe pain and other symptoms. Left untreated, ACL tears can lead to osteoarthritis and other problems. For athletes and younger people, regaining full use of the knee is very important.

About ACL Surgery

During ACL reconstruction surgery, the physician takes a small piece of a tendon or ligament from another part of the patient’s body and uses it to reconstruct the torn ACL. ACL surgery can usually be performed in an arthroscopic manner, meaning that tools and a camera are inserted through small incisions instead of opening up the knee.

If ACL surgery is performed arthroscopically, it can usually be done in an outpatient setting. Patients normally receive local anesthesia and sedation, and can return home the same day.

Insurance Coverage

Doctors recommend ACL surgery when it is medically necessary to restore function, relieve pain and other symptoms, and prevent the development of further orthopedic problems. Therefore, when ACL surgery is medically necessary, it should be covered by health insurance.

To get coverage from your insurance, you’ll need to go to a doctor who accepts your insurance plan. If you have PPO coverage, this means checking that the doctor is in your network.

Managing Costs  

Although insurance does cover ACL surgery, some patients have insurance plans that have a high deductible, which can result in a significant financial burden. For patients who cannot pay their share of the cost of ACL reconstruction surgery out of pocket, there are a number of financing options, like financing from patient financing firms, personal loans, or health care credit cards.

With the help of insurance and financing, the majority of patients are able to afford the treatment they need for their ACL tear.

Dr. Howard Marans of OC Orthopedic would be happy to meet with you about your knee pain. Please click below to schedule your consultation or call us at 714.979.8981.

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