A bunion (also called hallux valgus) is a bony bump that usually forms at the base of the big toe joint, causing 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, as with many healthcare procedures 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?
Dr. Bob Baravarian and his team 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.
Does insurance also cover operating room/surgery center fees?
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 Dr. Bob’s practice 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 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 help you?
Not only is Dr. Bob an internationally recognized expert in bunion surgery, but he also encourages patients to work with his billing specialists to clarify costs and navigate potential insurance claims.
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 (855) 557-5400 or make an appointment online now.
Sources
Does Medicare Cover Bunion Surgery? | Medicare & Medicare Advantage Info, Help and Enrollment
https://www.medicare.org/articles/does-medicare-cover-bunion-surgery
