A bunion (also called hallux valgus) is a bony bump that usually forms at the base of the big toe joint that causes it to deviate and push against the other toes. From the outside, it looks like a lump or growth, but it’s caused by a misalignment of the first metatarsal bone.
Sometimes, a bunion can involve the little toe, known as a “bunionette.”
Sadly, bunion deformities are very common and often painful. Experts estimate that the condition affects up to one-third of Americans.
Some people with bunions experience only mild bunion pain and discomfort. These fortunate folks can manage their symptoms with over-the-counter pain medications, custom orthotics, and by wearing sensible or “special shoes.”
However, when nonsurgical treatments don’t help, and your foot pain causes mobility issues or limits your daily activities (due to the limited range of movement in your toe), it may be time to consider surgery.
And with bunion correction surgery, like everything involving healthcare in America, there are costs associated with treatment.
Does health insurance cover bunion surgery?
The short answer is yes. Insurance will also cover most diagnostic tests, such as X-rays. However, policies often have a caveat: They may place limits on the type of bunion foot surgery or the type of implants or hardware they will pay for.
In other words, some insurance providers may limit coverage to those surgical bunion procedures that they consider the most cost-effective (or average cost) for your condition.
Are there some bunion surgery costs that are generally not covered by health insurance?
University Foot and Ankle Institute (UFAI)’s foot and ankle surgeons are among the leading experts on bunion care and treatment options in the United States. Thus, we are able to offer numerous surgical procedures, from traditional open bunion surgery to the newest minimally invasive techniques.
While “basic bunionectomy” procedures (such as an osteotomy) are eligible for insurance coverage, more advanced types of bunion surgery may not be. These include the Lapiplasty 3D Bunion Procedure (for moderate to severe bunions and the best option for those with joint laxity) or the Bunionplasty minimally invasive bunion surgery (which uses tiny micro-incisions that are just a few millimeters long, resulting in much less trauma to the surrounding soft tissue).
If you opt for one of these, consider adding some out-of-pocket expenses to your treatment costs.
Additionally, certain implants or hardware used during bunion surgery, such as plates, screws, or the metal-free Ossio fiber joint implants, may also not be fully covered even if they are believed to offer better results, faster weight-bearing time, and a faster recovery.
Does insurance cover multiple surgeries if they are done at the same time?
Sometimes, patients may have a big toe bunion and need bunion removal surgery but also suffer from a hammertoe. If so, you may choose to have both corrected at the same time, which will minimize your recovery time versus two surgeries.
Does insurance cover post-surgery recovery costs?
Post-surgical recovery costs are important to consider because you will want to get back on your feet (pun intended!) as quickly as possible. Things you will want to know if your insurance covers include:
- Physical therapy—even if your policy covers this, the number of sessions may be limited.
- Orthotics — custom orthotics may assist in the recovery process and help avoid future bunion formation or other foot problems.
- Mobility aids — crutches, a scooter, or surgical boots may be required to help with rehabilitation, particularly if your recovery is protracted.
Does Medicare cover the cost of bunion surgery?
Medicare Part B covers the costs of medically necessary treatments, including 80% of the total surgery cost, including any required supplies and follow-up visits to your podiatrist. If you have Medicare Part B supplemental insurance, it could cover up to 100% of your costs.
However, there may also be limits on the type of implants or hardware they will cover. You should also make inquiries to ensure you know exactly what your expenditure will be.
Are operating room/surgery center fees also covered by insurance?
The type of surgical facility your physician uses can also affect costs. Larger institutions have more bargaining power when negotiating with insurance companies, allowing them to secure higher reimbursement rates for surgery. However, this advantage often results in higher costs for patients.
Several factors are responsible for these increased costs:
- Hospitals such as UCLA or Cedars-Sinai have higher operational expenses (more admin staff, advanced equipment, and extensive facilities), which are passed on to the patient.
- Their reputation and perceived prestige can also lead to greater patient demand, allowing them to charge more.
- The care offered by these institutions includes the latest technology and specialized medical staff, which is not a component of bunion surgery. However, it still contributes to these facilities’ higher costs overall.
How do I find out what my health insurance policy will cover?
Understanding what is and isn’t covered under your policy can help you plan for a successful recovery and also help you organize your financial commitments.
Fortunately, patients at UFAI have the help of our surgery schedulers, who are very familiar with what your insurance plan will and will not pay for, as well as your insurance co-pay.
If you are not a patient of UFAI or want to do your own cost research, here are some tips for you:
Review your policy
Your first step should be to confirm what exactly is covered under your policy and then seek pre-authorization to avoid unexpected denials of coverage.
You’ll need to establish what elements are included in the surgery costs, such as specific implants or hardware that might be recommended.
You’ll also want to rule out nasty financial surprises, such as physical therapy or recovery aids, that may not be covered. Physical therapy may be included in your plan, but you should verify whether there is a limit on the number of sessions and whether more sessions can be authorized if necessary.
Other post-operative expenses might include custom orthotics or mobility aids. Ask your insurance provider exactly what is covered.
Out-of-pocket expenses
Look at all the potential out-of-pocket expenses. These might include co-pays, deductibles, and anything excluded from coverage, such as specific implants or hardware or anything else not included in surgery costs.
Patients should also maximize the use of FSAs or HSAs to cover medical expenses.
Is bunion surgery worth it?
If your symptoms are causing you pain, affecting your daily activities, restricting your mobility, and your podiatrist considers bunion surgery will relieve those issues, then yes, bunion surgery is worth it.
So, if attempts to manage your symptoms conservatively have failed, you are likely a good candidate for surgery and should consider going down this route.
How can our team at UFAI help you?
Not only is UFAI an internationally recognized Center of Excellence known for our bunion surgery expertise, but we encourage our patients to work with our billing specialists to help clarify costs and navigate potential insurance claim issues.
Taking the time to investigate and plan for all aspects associated with your surgery and recovery, obtaining pre-authorization from your insurance provider, and being prepared for any additional expenses that may not be covered will help give you peace of mind.
Let our team guide you through what’s required and what you need to prepare before undergoing bunion surgery so that you’ll be free to focus on your recovery and be back on your feet in no time.
For a consultation, please call (877) 736-6001 or make an appointment online now.
Bunion Surgery Insurance FAQs
What is bunion surgery?
Bunion surgery, also known as a bunionectomy, is a procedure to remove or realign a bony bump (bunion) at the base of the big toe. It corrects the misalignment and relieves pain. The procedure often involves repositioning bones, ligaments, and tendons to restore proper toe alignment and function.
Is bunion surgery covered by most insurance plans?
Yes, bunion surgery is typically covered by most health insurance providers if it’s deemed medically necessary, such as when the bunion causes significant pain, impairs mobility, or leads to other foot complications. However, coverage may vary, so you must check with your insurance provider about specific benefits and any potential out-of-pocket costs.
How do you qualify for bunion surgery?
To qualify for bunion surgery, you typically need to meet certain criteria, including experiencing persistent pain that interferes with daily activities, having significant difficulty walking, or not finding relief from conservative treatments like orthotics, anti-inflammatory medications, or physical therapy. Additionally, a doctor may recommend surgery if the bunion is causing other complications such as hammertoes, arthritis, or chronic inflammation that doesn’t respond to nonsurgical interventions.
How much does it cost to get a bunion removed?
The cost of bunion surgery can vary widely depending on factors such as the location, the surgeon’s experience, the type of bunion removal procedure you have, and the complexity of the procedure. On average, bunion surgery in the Los Angeles area can range from $3,500 to $10,000 without insurance (including surgeon fees, facility costs, anesthesia, and follow-up care).
If you have insurance, the out-of-pocket expense will depend on your plan’s coverage, co-pays, and deductibles.
What does bunion surgery entail?
Bunion correction surgeries use different techniques to correct the bunion deformity. This may include:
- Repositioning your big toe back to its correct place
- Realigning the tendons around the toe
- Shaving off the protruding part of the bunion (exostectomy)
- Removing the parts of the joint that were damaged by the bunion and using screws to fix the joint (arthrodesis)
- Inserting screws, splints, or pins to keep the joint in place (osteotomy)
Is lapiplasty bunion surgery covered by insurance?
Lapiplasty bunion surgery is often covered by insurance, including Medicare and private insurers, if it is considered medically necessary. Insurance typically covers procedures aimed at correcting significant foot deformities, alleviating pain, or improving mobility.
Does bunion surgery require general anesthesia?
No. Generally, a bunionectomy is performed under local anesthetic and doesn’t require you to stay overnight at a hospital or to “go under” completely.
How is post-bunion surgery pain managed?
Post-bunion surgery pain is typically managed through a combination of pain medications, such as prescription-strength anti-inflammatory and pain medications, for a short period of time. Most of the bunion surgeries performed by UFAI are managed by Tylenol.
Is there a home bunion treatment that works?
Some nonsurgical treatment options may help you limit the pain and mobility issues that bunions cause. But there is no cure for bunions except for bunion correction surgery.
What are the types of bunion surgery?
There are numerous types of bunion surgery tailored to the severity and structure of the bunion. These include an Osteotomy, the Lapidus Procedure, the Lapiplasty 3D Bunion Procedure, and the Bunionplasty minimally invasive bunion surgery.
What factors influence insurance coverage for bunion surgery?
Insurance coverage for bunion surgery is influenced by several factors, including:
- Medical Necessity: The surgery must be deemed medically necessary, which typically involves your podiatrist (also known as a DPM) documenting severe pain, difficulty walking, or complications like arthritis that significantly impact daily activities.
- Conservative Treatment Attempts: Insurance companies often require proof that nonsurgical treatments (e.g., orthotics, physical therapy, medications) have been tried and failed to provide relief before approving surgery.
- Type of Surgery: As discussed earlier in this article, Some insurance plans may cover only specific types of bunion surgery, particularly those considered necessary for restoring function and not cosmetic in nature.
- Insurance Plan Details: The specifics of your health insurance plan, including co-pays, deductibles, network coverage, and pre-authorization requirements, will also determine coverage and out-of-pocket costs.
- Provider Network: Using a foot and ankle surgeon and facility within the insurance provider’s network can impact coverage levels and reduce costs.
Does Medicaid also cover bunion surgery?
Yes, Medicaid may cover bunion surgery if it is deemed medically necessary. However, coverage depends on the state’s specific Medicaid program guidelines, and policies can vary. Please note that UFAI does not accept Medicaid.
Sources
Does Medicare Cover Bunion Surgery? | Medicare & Medicare Advantage Info, Help and Enrollment https://www.medicare.org/articles/does-medicare-cover-bunion-surgery
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