Dr Howard Marans: ACL Reconstructive Knee Surgery Costs

The anterior cruciate ligament (ACL) reconstructive surgery generally involves replacing or repairing the damaged ligament to restore function to the knee. In most cases, the replacement or reconstruction occurs from a graft within the patient’s body. A piece of tendon from the knee cap area or a piece of the hamstring is usually utilized to fix the ACL. The ACL reconstructive knee surgery cost will be dependent on a variety of factors. The main aspect in ACL surgery cost is medical insurance coverage.

ACL Reconstructive Knee Surgery Costs

If you have insurance, ACL reconstructive knee surgery cost is usually covered. In order for insurance companies to cover a majority of the surgery, the doctor will have to prove the procedure is absolutely necessary. The surgery coverage usually starts from the beginning with the initial diagnosis.

- An orthopedic surgeon will conduct an evaluation of the knee prior to recommending an ACL reconstruction procedure. The evaluation is critical for the insurance to cover the surgery.

- The patient will have to attend all preliminary appointments prior to surgery. Each step is vital for the insurance to cover the procedure. In some cases the insurance company may require physical therapy prior to the surgery. The sessions will be used as proof of the deterioration of the knee.

- A diagnostic study of the knee and various lab tests will be required.

- The surgery will be the next step in the ACL reconstructive knee surgery cost to be covered by insurance. The surgery coverage usually consists of the anesthesia, the reconstructive process, and the hospital stay.

With insurance, a patient may be required to pay out-of-pocket costs for a certain percentage. Speaking to the insurance provider prior to surgery will give the patient an idea about copays and deductibles that may be applied to the final cost. If a patient does not have any health insurance or limited insurance coverage, the out-of-pocket cost for the surgery may exceed $50,000.

After Surgery Care

The ACL reconstructive knee surgery cost will include after surgery care which is vital for the knee to heal properly. Failure to follow all the aftercare instructions could lead the patient right back into to the beginning of the process.

- The additional costs may include medical equipment to aid in the patient’s recovery. The patient is normally required to use crutches and to wear a knee brace in order to keep the leg straight during the healing process. Without insurance, the costs could be over $500.

- The costs of pain medication, either over the counter or prescribed.

- Physical therapy sessions are needed for the knee to regain full range of motion and usage. Physical therapy sessions can last for weeks after the surgery. A patient could be attending 2-3 sessions a week depending on the doctor’s orders. Each session can cost over $100 if not covered by insurance.

With or without insurance, ACL knee reconstructive surgery is essential for the patient to return to an active lifestyle. After an evaluation of the patient’s knee, Dr. Howard Marans can explain all the necessary steps for ACL reconstructive surgery including all the aftercare procedures. Dr. Marans welcomes PPO and will work with other insurance companies to give the best treatment available. Please click below to schedule your consultation or call us at 714.979.8981.