Is Bunion Surgery Covered Under Medical Insurance?

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A bunionectomy (also known as hallux valgus surgery or simply bunion surgery), is an outpatient surgical procedure that may be covered by your health insurance carrier, depending on the specific coverage guidelines set forth in your plan document. It is generally never covered for strictly cosmetic reasons.

A bunionectomy may be covered under your insurance.
A bunionectomy may be covered under your insurance. (Image: bojan fatur/iStock/Getty Images)

About Bunions

A bunion is actually a symptom caused by hallux valgus, which is the lateral deviation of the big toe beginning to point towards the center of the foot. This usually causes inflammation and thickening along the base and side of the big toe, technically known as the metatarsophalangeal joint. This inflammation and thickening is referred to as a bunion.

A bunion is a symptom caused by hallux valgus.
A bunion is a symptom caused by hallux valgus. (Image: ju-hyun lee/iStock/Getty Images)

Symptoms of a bunion

Hallux valgus may not cause any noticeable symptoms at first. As the big toe continues to point towards the center of the foot, several symptoms may present. The skin along the inside edge of the big toe may become red and calloused as it rubs along your second toe. There may be a bony bump along the outer edge of your foot along the joint. Most noticeably, pain along the joint will begin to develop as the inflammation and thickening worsens, which can be aggravated by the pressure from wearing shoes.

Pain along the joint is a symptom of hallux valgus.
Pain along the joint is a symptom of hallux valgus. (Image: phototake/iStock/Getty Images)

Conservative treatment for bunions

Normally before your health insurance company will authorize coverage for a bunionectomy, they will require that you see a physician, normally a podiatrist, and exhaust all conservative treatment first.

Because consistently wearing shoes that are too tight is one of the leading causes of bunions, wearing shoes with plenty of room when hallux vagus first begins is a logical first step.

Your physician may also use tape and padding to keep your foot in a normal position to help correct the problem. Shoe inserts (known as orthotics) may also be prescribed to help keep your foot in a normal position.

Medications may be prescribed to help deal with the pain of a bunion, as well as reducing the inflammation.

Your insurance will make sure you have exhausted all conservative treatment methods before considering surgery.
Your insurance will make sure you have exhausted all conservative treatment methods before considering surgery. (Image: Fuse/Fuse/Getty Images)

When Conservative Treatment Fails

If conservative treatment fails in either correcting the problem, halting its progress or relieving the symptoms, your physician may decide to perform a bunionectomy. If your physician has thoroughly documented the diagnosis, progression, and failed conservative treatment of your disease, then your insurance company will generally authorize coverage the bunionectomy.

After conservative treatments fail, your physician may decide to perform a bunionectomy.
After conservative treatments fail, your physician may decide to perform a bunionectomy. (Image: matthew Zinder/iStock/Getty Images)

Know your plan coverage

While your physician may determine that a bunionectomy is the next step, that in itself is not a guarantee that your health insurance carrier will cover it, or even cover it in full if they do. Some plans have specific dollar limitations on foot care per benefit year; if your surgery is $10,000 total, but your health insurance carrier has a $5,000 per benefit year limitation on foot care, you would be responsible for the $5,000 balance.

If the only symptom of your disease is the unsightly appearance of your big toe beginning to point in towards the center of your foot, your insurance carrier may consider a bunionectomy cosmetic in nature and deny permission for surgery.

Health insurance carriers all have different guidelines they use to determine the medical necessity of a procedure and different coverage policies for how much they will pay for any particular procedure. It is important that you contact them and follow the preauthorization procedures to get your surgery approved.

Make sure you know your plan coverage.
Make sure you know your plan coverage. (Image: Francesco Ridolfi/iStock/Getty Images)

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