If you need shoulder surgery, getting your insurance coverage worked out beforehand can help the process go as smoothly as possible. You should be able to get shoulder surgery covered by insurance, since it is used to treat a medical problem. Therefore, the biggest factor that determines what you pay is your insurance coverage.

Types of Shoulder Surgery Covered by Insurance

There are two main types of shoulder surgery: arthroscopic shoulder surgery and conventional shoulder surgery. During arthroscopic surgery, the doctor makes tiny incisions near the area he is operating on, then inserts a camera and tools through these incisions. That way, the doctor can operate on the shoulder without opening it up. During conventional shoulder surgery, the doctor makes a large incision and peels back skin and other tissue to access the shoulder.

The recovery time from arthroscopic shoulder surgery is much shorter than that for open shoulder surgery, and there is usually no need for a hospital stay. In addition, arthroscopic surgery is less expensive to perform. For those reasons, shoulder surgery should be performed arthroscopically whenever it is appropriate to do so.

Insurance Coverage

You should be able to have your shoulder surgery covered by insurance, so be sure to choose a doctor who accepts your insurance plan, or a doctor who is in-network if you have PPO insurance. Once you provide your insurance information to your doctor, the doctor will bill your insurance. If your insurance company objects to covering the procedure, your doctor can advocate to have the procedure covered; however, this is not usually necessary for shoulder surgery.

Since you should have your shoulder surgery covered by insurance, the biggest factor that determines your out-of-pocket costs is the terms of your insurance coverage. A higher deductible means you pay more directly for the surgery. If you are not sure about how your insurance covers shoulder surgery, you can contact your insurance provider for more information.

Managing Your Out of Pocket Costs

There are a number of methods for managing your out-of-pocket costs. If you have enough in your regular savings or have a health care savings account, you may be able to pay your portion of the cost of treatment without any trouble. If your costs are higher than you can pay all at once, you can apply for financing to spread the cost of treatment out over a longer period of time.

Dr. Howard Marans would be happy to meet with you about your shoulder injury. To schedule your consultation today, please click below and enter your information or call OC Orthopedic at (714) 979-8981.