What is the Cost of Bunion Surgery With Insurance?

Bunion surgery is a scary word to most people, and it is often due to more than just fear of the unknown and fear of the pain. To many, bunion surgery comes with a cost that forces them to put their health on the backburner. Fortunately, for most people, if you do your research and plan accordingly, the cost of bunion surgery can be managed.

What is Bunion Surgery?

Bunions involve the removal or realignment of your toe joint’s soft tissue and bone. Usually, your foot and ankle surgeon will make an incision on the top or side of the toe joint.

Then, depending on the type of surgery you’re having, surgeons may work to remove bone lumps, realign bones, or fuse joints together, using screws or plates to hold bones in place.

If you have a bump on the side of your bit to a joint that forces your toe against your other toes, it could be due to a bunion. In the past, bunion surgery has been known to be very painful and come with a long recovery period, but fortunately, new surgery that is less invasive and has a shorter recovery time is an option for some people.

Bunions will not simply go away on their own and typically get worse as time passes. They can cause problems with your feet, knees, legs, hips, and back which eventually lead many people to choose surgery to correct the painful condition.

Bunion surgery typically requires an incision to be made along the side or top of your big toe and the removal or realignment of soft tissue and/or bone. Although this is the most typical type of surgery, there are over 100 types of surgeries for bunions and most of them are done on an outpatient basis.

Your bunion has gone from an annoyance to a constant source of pain. You’ve tried everything from pads and splints to specialty shoes to relieve bunion pain without surgery. But every day it seems like it’s getting harder to avoid pain and discomfort.

Bunion Surgery is a procedure that corrects the foot deformity that occurs when the big toe joint protrudes and the big toe angles inward toward the other toes.  Historically, the surgery is very painful and takes months to heal.  A new surgery called minimally invasive bunion surgery offers almost no pain and a  fast recovery.

If you’ve noticed a bump on your main big toe joint, and your big toe is forced against the others, you probably have a bunion. For most people, they are uncomfortable at best. They can be extremely painful and life-limiting.

Bunions do not go away naturally. In fact, they become worse over time. They can cause serious issues with your feet, legs, and back.

Bunion surgery also called a “bunionectomy”, is necessary once a bunion becomes painful and starts affecting your quality of life.

When the procedure is minimally invasive, it costs considerably less, as there is no need to pay for a hospital stay or the medications to put you under.  In fact, clients actually walk out of minimally invasive bunion removal surgery.

What Determines the Cost of Bunion Surgery?

The average cost of bunion surgery in the United States can range anywhere between $3,500 and $12,000 or more. But your actual out-of-pocket cost may be far less.

Insurance and location will affect the cost of most surgeries. The hospitals and doctors you have access to are the first things that will impact the cost of your surgery. The same goes for the neighborhood you live in. People who reside in metropolitan areas always have more options.

Your insurance company negotiates the network rate with your doctor and hospital. That means that these two parties will have a large influence on the cost of your bunion surgery.

This is not to say a person doesn’t have options. People should be open to getting a second and third opinion. An insurance company will always offer you more than one doctor.

There are a variety of factors that can impact the cost of bunion surgery, but research shows that the average price for bunion surgery is around $5,560, but can be as little as $3,500 or over $12,000. Insurance and location are two factors that can play a role in that cost. People that reside in a metropolitan area are almost always likely to have more options.

If you have insurance, they will negotiate a network rate with the hospital and doctor of your choice. This isn’t to say that you won’t have options, but those parties will have a huge impact on the cost of your surgery.

The type of procedure that you will have will also play a role in the cost of your surgery. If you have a more traditional surgery that requires a hospital stay, that cost will be more than an outpatient surgery. If an emergency happens during your surgery, this will also result in additional costs.

Your own health can play a role in the cost of surgery as well. If you have certain health conditions, it may make some types of bunion surgery impossible, or it may result in a longer recovery period. If you are relatively healthy and are able to have a minimally invasive procedure, it may be less expensive and result in less time off work.

The type of procedure required and what happens during the operation, are other factors that go into the cost of bunion surgery. Traditional methods require hospitalization. If an emergency occurs during the surgery, there will be additional costs.

Bunion surgery costs depend on the type of surgery you have, where you have the procedure, your health insurance or Medicare coverage, and more.

Generally, if your bunion pain is leading to physical limitations, and surgery is deemed medically necessary by your podiatrist, insurance will cover the procedure. But how much your insurance will cover depends on the plan you have.

Lastly, personal health can play a role in the cost of bunion surgery. Certain health problems can make traditional bunion surgery harder. But, minimally invasive procedures might be less expensive. In addition, you won’t have to miss much work.

Insurance and Bunion Surgery

If you have insurance, it is likely that it will cover at least part of the procedure. Bunions that are causing a change in the way you walk or causing you pain are considered medically necessary. However, if your bunion is small and does not cause changes in your gait or result in pain, your insurance may refuse to cover the cost of surgery.

Of course, some insurances have a deductible, co-pay, or co-insurance that will impact how much you have to pay out of pocket. If your doctor is out of network, this can also lead to additional costs.

Your insurance will almost always prefer that you use providers of their choice, but that doesn’t mean you are required to do so. Your health should always be your primary concern if at all possible.

Insurance will probably cover part or all of the surgery because the majority of bunion surgeries are not cosmetic. A bunion that is causing pain or changing the way you walk, is considered medically necessary. If it is small and causes no pain, insurance may not cover the procedure. The type of insurance and plan you have will affect the cost of your bunion surgery.

Your co-pay, co-insurance, and deductible all affect your bottom line. If you choose a surgeon that is out-of-network, it can also lead to exorbitant costs.

Your insurance company wants you to go to the people they struck a deal with, but that doesn’t mean you have to. Your health should always be the most important factor in any medical decision.

Medicare and Medicaid generally cover foot care. This is because 35% of people over the age of 65 suffer from some form of a bunion. As long as it’s medically necessary, most insurers will cover the procedure with proof of pain/discomfort from a doctor.

When is bunion removal surgery usually recommended?

Bunion removal surgery is typically done for two reasons:

  • Nonsurgical treatments are losing their effectiveness or no longer working to manage bunion pain.
  • The pain, size, or shape of the bunion is affecting your daily life, making it hard to do everyday activities.

Does bunion surgery actually work?

How well bunion removal surgery works for you will depend on a variety of factors, such as the type of surgery you have and how bad your bunion is.

But many people find that bunion surgery reduces joint pain, improves toe mobility, and makes it easier to walk and resume normal daily activities. And once post-surgery swelling has gone down, toes often look more normal than they did before.

What are the different types of bunion surgery?

There are more than 100 surgeries for bunions – and more than one procedure may be done at the same time. Some of the most common surgeries include:

  • Exostectomy or bunionectomy: These procedures involve removing part of the metatarsal head, which is the bunion bump that bulges out from the toe joint.
  • Realignment procedures: the big toe often turns in as a bunion grows, which is often the major source of pain. Realigning bones (osteotomy) or ligaments helps restore toes to their normal position to relieve pain.
  • Fusion Surgery: Fusion surgery helps stop the movement between two bones, helping reduce pain. Two common fusion surgeries for bunions are:
    • Arthrodesis to fuse the bones that form the big toe joint
    • The Lapidus procedure to fuse the joint between the metatarsal bone and the mid-foot
  • An Implant: An implant procedure involves replacing part or all of the damaged toe joint with an artificial joint.

How long does bunion surgery take?

The amount of time bunion surgery takes depends on a few different factors, including the type of surgery you’re having and whether multiple procedures are being done at the same time.

Typically, you can expect the surgery itself to take an hour or more, but you’ll be at the hospital or surgery center for a couple of hours before and after your procedure. Bunion surgery is usually done as an outpatient procedure, which means you’ll go home to recover on the same day as your surgery.

Is bunion surgery painful?

No, the surgery itself isn’t painful. A local anesthetic will be used to numb your foot so you don’t feel any pain. You will also be given a sedative to help make you more comfortable.

What are the risks of bunion surgery?

Bunion surgery is common, and the likelihood of serious complications is low. But like every surgery, bunion removal does come with risks.

Some surgery risks include infection, a reaction to anesthesia, and bleeding. Other risks specific to bunion surgery can include the recurrence of a bunion, decreased sensation, or tingling, numbness or burning in the toe, stiffness, arthritis, and more.

Your care team will walk you through potential risks before surgery as well as the steps being taken to reduce them.

How long does it take to recover from bunion surgery?

Your bunion surgery recovery timeline depends on the type of surgery you have, your overall health, and other factors. Typically, the initial recovery period is anywhere from six weeks to six months, but complete healing can take up to a year.

As part of your recovery, your surgeon may recommend physical therapy to strengthen foot muscles and improve mobility. But what else can you expect in the first days and weeks after bunion surgery? Here’s a high-level look:

  • Day one of bunion surgery – One of the biggest questions on your mind may be: Can you walk after bunion surgery? And the answer is, “Yes, but not without assistive devices like crutches or a scooter.” When you leave the hospital or surgery center to begin your recovery, you’ll be wearing a removable boot cast or special shoe to protect your foot and keep your toe in the right position.
  • How long do you wear a boot after bunion surgery? This protective footwear will be part of your wardrobe for at least three to six weeks after surgery – but could be used for several months. Depending on the type of surgery you had, you’ll be instructed to keep some or all the weight off the affected foot, which is why you’ll need assistive devices to help you get around.
  • The first week after bunion surgery – You’ll notice some discomfort, pain, and swelling as your foot begins to heal after surgery. To relieve pain and swelling and speed recovery, you’ll likely be instructed to keep your foot elevated as much as possible throughout the day and to apply ice for 15 to 20 minutes a few times per day.
  • One to three weeks after bunion surgery – Pain and swelling are likely to decrease with each passing day, and you may be spending less time with your foot elevated. If your boot or special shoe is still around, you can expect to get any stitches removed seven to 21 days after surgery.
  • Four to six weeks after bunion surgery: If you’ve been wearing a boot or cast, you may be able to switch to comfortable shoes that have enough room for remaining swelling. And your activity levels can increase as you feel better.
  • Six to 12 weeks after bunion surgery: If you didn’t have to complete a no-weight-bearing period during recovery, most activities can be resumed around six or eight weeks. But if you did, this may be the end of that period and the start of your being able to put some weight on your foot.

Is bunion surgery right for you? Talk with a podiatrist.

Surgery is the only way to remove bunions after they form and become a problem. If the non-surgical treatments you’re using have stopped working or are becoming less effective, and the pain has started to impact your ability to perform daily activities, surgery may be an option.

If you’re wondering if surgery makes sense, talk with a podiatrist. Most podiatrists are also foot and ankle surgeons who can perform the procedure and provide follow-up care. And those who aren’t surgeons can refer you to colleagues who are.

Medicare and Bunion Surgery

Medicare will typically cover foot care, including bunion surgery, as long as it is considered medically necessary. Approximately 35 percent of people ages 65 and over in the U.S. suffer from bunions. Fortunately, Medicare Part B provides coverage for medically necessary supplies and services.

As a general rule, Medicare will cover 80 percent of the total cost of bunion surgery. The remaining 20 percent will be your responsibility to pay unless you have a secondary insurance policy to cover the difference. Deductibles and copays may also apply in certain situations.

Getting the Best Care

Keep in mind that you are not required to see a certain surgeon or have a certain procedure just because of your insurance. You have the right to seek out the best care that you can afford. Here are a few tips for getting the best care for your money:

  • Compare and research local surgeons and get an estimate from them.
  • Ask your insurance about their fees before your surgery including deductibles, co-pays, and co-insurance.
  • Use your flexible spending account, health savings account, or health reimbursement account if you have one to cover additional expenses.
  • Speak to your doctor and see what options they may have available to help reduce the costs you will be required to pay out of pocket.

You should not avoid bunion surgery simply because of your fear of the cost. The longer you put off surgery, the worse your bunion will likely get, which will make it even more expensive to fix when you can no longer avoid surgery.

However, after talking with your podiatrist, it is determined that your bunion doesn’t require surgery, ZenToes has several products that can help relieve bunion pain and align your big toes, such as our Gel Toe Separators and Bunion Guards.

The word “surgery” is frightening for many reasons. Beyond the fear of pain and the unknown, the cost is also on people’s minds. Your wallet should never come before your health. As long as you plan properly and do your research, the expense of any surgery can be managed.

Foot surgery comes with many different costs. Loss of work and hospital fees alone can scare some away from having surgery. Before deciding against it, it is important to understand your condition and the options available.

The Best Care for Your Money

You are not tied to a certain surgery because of your insurance company. An individual has a responsibility to seek out the best care possible for what they can afford.

Even when insurance covers a portion of the cost, people are still likely to pay something out of pocket. Here are a few ways in which you can make sure you’re getting the most for your money:

  •  Research and compare local surgeons. Call and get an estimate.
  • Ask your insurance company about all costs upfront. That includes co-pays, deductibles, and co-insurance.
  • Take advantage of a Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Account (HRA) to cover any additional expenses.

An individual can always speak with their doctor as well. Doctors are compassionate people and will be willing to work with you to help reduce costs if you are paying out of pocket.

FAQs

Is bunion surgery covered by health insurance?

It depends. If the bunion is causing pain and interfering with your normal life, it is considered a medical condition and is usually covered by health insurance.

If the bunion surgery is done for purely cosmetic reasons, it is not considered a medical condition, and health insurance will usually not cover it.

What are the hidden costs of bunion surgery?

Conventional open-foot bunion surgery comes with a high hidden cost of weeks or months of missed work and wear and tear on those who have to take care of you throughout the weeks and months of recovery.

Minimally invasive bunion surgery avoids these hidden costs completely because you don’t have to miss work and you are never immobilized so no one has to take care of you.

Do they put you to sleep for bunion surgery?

Conventional open-foot bunion surgery requires you to be put to sleep. During minimally invasive bunion surgery, a local anesthetic is used on the foot, and you remain awake and aware throughout the procedure.

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