The Center for Podiatric Care and Sports Medicine

Will Insurance Cover My Bunion Surgery?

Posted by on Friday, September 19th, 2014

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When deciding if you truly want a bunionectomy or not, there’s much to consider. You will need to spend some time off your feet as you recover. You may lose some flexibility in your toe joint. Surgery may improve your foot’s appearance, but people who elect for surgery just to get a “designer foot” often end up disappointed. Worse yet, some insurance companies don’t view bunions as a “medical necessity,” and therefore do not cover the procedure.

Anyone who has had a bunion for a long time knows that they can be very painful, irritating, and downright depressing! There are many factors that go into a bunion surgery’s price, however, so do let us know if cost is an issue for you and we will see what we can do to bring the cost down as much as we can. There are also some circumstances where part or all of your procedure will, in fact, be covered.

More health insurance companies will cover a bunion procedure than you may think. It all depends on the circumstances present.

 

bunionectomy insurance
Your health insurance provider may cover bunion surgery, depending on the circumstances. Image Source: HealthPlansNY.com

 

When Are Bunion Procedures Covered by Insurance?

Insurance companies will give you all sorts of excuses as to why they will not cover a “cosmetic” bunion procedure. According to Aetna, they consider simple bunionectomy and bunionette surgeries to be “experimental and investigational” for indications other than a few specific instances outlined in their policy.

For instance, they will cover surgery when:

– The hallux valgus angle is 30 degrees or more and the inter-metatarsal angle is 12 degrees or greater (bony protrusion)

– The HVA is 15 degrees or more with no degenerative changes at the joint and six months or more of failed management (soft tissue)

– The patient has a diabetic foot ulcer or infection stemming from the bunion, specifically

– Pain symptoms make walking difficult, despite at least six months of protective pads, shoe inserts and alternative footwear

– The bunion has caused a neuroma

– There is a cross-over toe deformity

– The patient suffers recurrent bursitis

– There is x-ray evidence of osteoarthritis

There are other specific instances where they may cover joint fusion surgery or other procedures listed here.

 

How to Get Your Insurance Provider to Cover Your Bunionectomy

First, you will need to demonstrate that you have unsuccessfully tried conservative treatments for your bunion. Working with a podiatrist, you will likely need to buy special padding, invest in properly fitted and comfortable shoes, refrain from wearing high heels, and take anti-inflammatory drugs. Next-level treatments may include cortisone shots for acute pain, custom-made orthotic shoe inserts, and night splints to straighten the toe out. Next, your insurance company will require x-ray evidence that the bunion is bad enough to warrant surgical correction. Your surgeon may then need to make a case as to why a particular procedure is necessary for your situation, as there are over 100 procedures that may be done to correct a hallux valgus deformity.

 

Other Options to Pay for Bunion Surgery

CostHelper.org gives ballpark figures for bunion treatment costs but explains that procedures vary based on the treatments used, whether the procedure is done at a hospital or in-office, and the kind of anesthesia used.

Sometimes you can get the procedure covered by a CareCredit loan, which offers low monthly payments, no annual fees, no prepayment penalties, and credit line increases on existing accounts. You can also apply Health Savings Accounts toward bunion surgery.

 

Bunion Surgery in NYC

The Center For Podiatric Care and Sports Medicine will make sure you have access to the care you need, whether it’s surgery or more conservative methods. We accept many different insurance plans and work with uninsured patients as well. Contact our office to discuss your options.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.