What Types of Surgeries are Covered by My Health Insurance?

Many health insurance plans fully or partially cover surgical procedures deemed ‘medically necessary’ by a healthcare professional. Each year, around 15 million Americans undergo surgical procedures. If you plan to get surgery, it is important to ensure it fits within your health budget. Most people depend on their health insurance to cover the cost of surgery. 

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Average Costs for Common Surgeries

Surgical procedures are by far the most costly service in healthcare. When a patient pays for surgery, they don’t just pay for the procedure, but also the physician, the anesthesiologist, the equipment, operating room, medication, and the hospital room. Here is a list of most common ‘medically necessary’ surgeries and their average cost in the States. 

Average Cost of Common Surgeries

What is considered ‘Medically Necessary’?

Medicare defines ‘medically necessary’ as “Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.” It is a term used in the healthcare insurance industry to describe the coverage offered by a health plan. Every health insurance company has its own policies to identify what is a medically necessary service. Typically, these services are:

• Provided for the diagnosis, treatment, cure, or relief of a health condition, illness, injury, or disease
• Necessary for and appropriate to the diagnosis, treatment, cure, or relief of a health condition, illness, injury, or disease
• Within the generally accepted standards of medical care in the community
• Not solely for the convenience of the insured, the insured’s family, or the provider

Elective vs Necessary Surgeries

An elective surgery is a procedure that the patient can choose to have or not have. It may be medically necessary or it may not be. This classification depends on the patient’s medical professional, their insurance company’s policies, or in the case of Medicare or Medicaid, on the federal government. Even if a procedure is elective, most health insurance plans will pay for them, as long as they are deemed necessary.