Dr. Bates shares whether insurance will cover a woman’s hip replacement.
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At this time, most insurance will cover a hip replacement. I think more importantly, does your doctor accept your insurance? Which is a big issue here in Southern California. It’s becoming a bigger issue nationwide. It’s even a concern amongst the medicare population where most of our joint replacements come from because medicare’s reimbursement rates have substantially declined over the last years as our cause of doing business, i.e our overhead, our bills, our ability to pay our employees’ increases. So the current reimbursement in our county for a hip or knee replacement is approximately $1500. Now, when you take away the overhead that we pay to run our offices and then you give a bit to Uncle Sam, you’re left with very little. So some physicians have opted out medicare meaning they have no longer agreed to participate in a medicare program and that leaves a lot of elderly patients without the ability to go see a quality physician. Currently, many joint replacement doctors are still opt in to medicare, but as things continue to worsen, that could change and that’s a concern that is well-known amongst the orthopedic community and hopefully the public will start to become more aware of our dilemma in regards to this.
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