Lapiplasty® & Insurance Coverage

Navigating the world of medical procedures, insurance coverage, and associated costs can be daunting. For many patients considering Lapiplasty®, the paramount question on their minds is: “Will my insurance cover the cost?” At Dovetail Orthopedics, we understand the importance of budgeting for healthcare. So, let’s delve into the details of insurance coverage for Lapiplasty®.

Insurance and Medicare Coverage for Lapiplasty®

In general, Bunionectomy and joint fusion procedures utilizing the Lapiplasty® System are typically covered when deemed appropriate. Such alignment with insurance and Medicare makes the procedure more accessible for many, paving the way for pain-free feet.

When discussing Lapiplasty®, insurance and Medicare typically cover Lapiplasty® as long as the procedure is medically necessary. The best way for you to know if your insurance will cover Lapiplasty® surgery is to call Dovetail Orthopedics at (904) 430-7132. We will ask you a few questions about your condition, your medical coverage, and schedule you for a consultation to determine eligibility and out-of-pocket costs.

Why Lapiplasty® is Covered by My Insurance

The world of insurance can be intricate, with each plan varying in its terms and coverage. For many patients, understanding why and when a medical procedure, such as Lapiplasty®, is covered can be a maze to navigate. However, the key often lies in the phrase “medically necessary.” Let’s unravel this a bit.

Defining “Medically Necessary”

Insurance companies typically use the term “medically necessary” to categorize procedures, treatments, or services essential for the diagnosis or treatment of a medical condition, or to improve the function of a malformed body part. The purpose is not to enhance one’s physical appearance or for mere convenience. Here’s a breakdown of the considerations that insurance companies use to determine medical necessity:

  1. Purpose of the Procedure: The treatment should be in response to a diagnosed medical condition, not just for the enhancement of physical appearance or comfort. In the case of Lapiplasty®, the procedure addresses the root cause of bunions, a genuine orthopedic condition, rather than being a cosmetic correction.
  2. Efficacy and Safety: The procedure should be deemed safe and effective. If there are multiple treatments available for a condition, the insurance might cover the one that’s proven to be most effective and safe.
  3. Standard of Medical Care: The treatment should align with generally accepted standards of medical practice. If it’s an experimental or unproven method, insurance is less likely to cover it.
  4. Least Costly Alternative: Sometimes, insurance companies will only cover the least costly treatment option if it’s considered equally effective as more expensive alternatives.

How This Relates to Lapiplasty®

Given Lapiplasty®’s focus on rectifying a genuine orthopedic condition, it’s often seen as medically necessary. The procedure isn’t merely cosmetic—it’s designed to correct a misaligned toe bone, which is the underlying cause of bunions. This aligns with many insurance companies’ criteria for medical necessity, making it more likely to be covered.

However, as always, there are nuances. Coverage for Lapiplasty® can be subject to your specific insurance plan’s deductible, coinsurance, and maximum out-of-pocket limits. Thus, before embarking on any medical journey, it’s crucial to have a thorough discussion with Dovetail Orthopedics, (904) 430-7132. We will help you understand your insurance provider’s policy, your coverage, and potential financial responsibility.

The Lapiplasty® Difference: Addressing the Root Cause

Why opt for Lapiplasty®? Traditional bunion treatments often focus on the surface, not addressing the root cause of the issue. Lapiplasty®, on the other hand, corrects the misaligned toe bone, which is the primary source of bunions. Beyond this unique approach, the Lapiplasty® procedure also offers patients the advantage of a significantly shortened wait time before they can bear weight on the treated foot. This means getting back to your normal routine faster and with greater confidence.

Insurance Coverage and Lapiplasty®, Next Steps

Don’t let the fear of costs and coverage deter you from seeking the relief you deserve. If you’re plagued by bunions and are seeking a lasting solution, Lapiplasty® might just be the answer. Find out if you may be a candidate today! At Dovetail Orthopedics, we’re here to guide you every step of the way. Contact us to learn more and take that crucial step towards a pain-free future. Call (904) 430-7132, or complete our short questionnaire to learn more about Lapiplasty® insurance coverage.