Getting knee surgery with private health insurance

The benefits of using medical insurance for knee surgery

A survey from 2023 carried out by the Guardian indicated that 272,000 people in the UK accessed healthcare privately.¹ According to data gathered by Statistica, in 2022, nearly 11% of the UK population took out private health insurance.² And this is all in spite of the NHS providing healthcare for free. Those that have private health insurance can enjoy the following benefits of private healthcare:

• Shorter waiting times when it comes to consultation and treatment
• Consistency of care with the same consultant and medical team with you throughout your journey
• The ability to choose the time, date, and consultant to carry out your procedure.

Does health insurance cover knee replacement surgery?

This depends on the type of insurance you have and who your insurance provider is. Health insurance tends to cover a wide range of medical treatments and conditions but it’s worth checking with your provider before you do anything. For example, as total knee replacement surgery is a common procedure in the UK, it’s likely to be included on most policies but it’s also a good idea to check with your provider. Partial knee replacement surgery on the other hand is a less common procedure, so may not feature as commonly.

How to check if your insurance covers knee replacement surgery

The first step is to call your insurer. When you do, make sure to have your membership or policy number to-hand. When you’ve got them on the phone, you’ll need to mention where you’d like to have your treatment.

Common insurance requirements for knee replacement

There are a few requirements insurance providers may look for before you can be covered for knee replacement surgery.

• Pre-existing condition
  It’s unlikely you’ll be able to make a successful claim on knee replacement surgery if your need for treatment predates your policy. In other words, you cannot take out a health insurance policy after you learn about your need for a knee replacement.
• Surgery criteria
  There are certain physical and mental criteria you need to meet before health insurance providers will cover your surgery. For example, you’ll need to be under a certain weight to be eligible. You may also need to make certain lifestyle changes such as cutting down on smoking or alcohol consumption before you can be covered.
• Age
  Your age can play a big role. The older a patient gets, the more potential there is to encounter the risks associated with major surgery.

How much does knee replacement cost with insurance?

This depends on the level of cover you have. The more comprehensive policies tend to be more expensive but are more likely to cover the full cost of your treatment. Policies covering fewer elements and conditions are likely to have lower premiums. Policy premiums are also affected by age and whether or not pre-existing conditions are fully underwritten.

How much does a knee replacement cost without insurance?

If you don’t have health insurance but still wish to have your treatment privately, you’ll need to pay the going price. According to MyTribe, as of August 2023, the average cost of knee replacement surgery in the UK is currently £15,138.³ Knee replacement surgery with Wellsoon from Practice Plus Group costs £13,149 (plus £95 for the initial consultation). This price is inclusive of surgeon fee, hospital stay, post-op medication and equipment, and physiotherapy sessions needed for your recovery.

What if my insurance doesn’t cover knee replacement?

In the event your health insurance policy doesn’t cover knee replacement surgery, you’ll need to consider your options and make an informed decision about the direction of your treatment. There are three main options available to you at this point:

• Pay for yourself in one lump sum – before you choose to pay for your knee replacement operation yourself, you’ll need to carefully consider whether you can afford it. A knee replacement at Wellsoon from Practice Plus Group costs £13,149 and while this is among some of the most affordable pricing in the UK, it’s still a lot of money!
• Pay for yourself via a payment plan – financing your knee surgery and spreading the cost over a fixed period of time represents a flexible option. Whilst knee replacement surgery can be costly, spreading the cost over a fixed period of time can make the financial burden easier to bear.
• The NHS route – the main benefit to having your knee replacement with the NHS is it’s free. But as you’ll likely be aware, the NHS is currently experiencing unprecedented waiting times. In some areas of the UK, patients are waiting a long time for treatment. For example, according to the My Planned Care NHS website,⁴ the current waiting time for orthopaedics at the North Cumbria Integrated Care NHS Trust is 15 weeks for an initial consultation and then another 30 weeks for the treatment itself. There are also long waits in the South-west (34 weeks total for orthopaedics at the Somerset NHS Foundation Trust), South-east (42 weeks at the Buckinghamshire Healthcare NHS Trust), and East Anglia (65 weeks at the Bedfordshire Hospitals NHS Foundation Trust).
  
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Best medical insurance for knee replacement surgery

From Fernando Alonso’s thumbs to David Beckham’s legs, the sporting world is awash with cases of athletes insuring prized body parts in the event of injury or worse. However, unless your knees are capable of a great and unique skill, you’re unlikely to be able to find knee insurance. What you will be able to do though is take out health insurance to cover the possibility of needing a knee replacement in future. While we can’t point you in the direction of the best policy around, we can provide a few words of guidance. 

First, if you’re thinking of taking out health insurance, make sure the policy covers knee replacements. Generally speaking, the more comprehensive the policy, the more likely it is you’ll be financially covered for a wide range of health conditions. So, it’s important to make sure you’re comfortable with what is (and isn’t) included in your policy, along with your premium.

Step-by-step guide to getting a knee replacement with insurance

So, we’ve covered the benefits and costs of accessing knee replacement surgery with (and without!) health insurance. Now, it’s time to take a look at how you access treatment, from initial consultation to getting the surgery date on your calendar. 

1. Consult your GP or a knee specialist

If you’ve been experiencing prolonged and persistent knee pain, it’s a good idea to seek medical advice. Your GP should be able to give you an idea of what the issue is and refer you for:

• Diagnostic tests and/or
• A consultation with a specialist

2. Check your insurance policy – confirm coverage and any exclusions

If you have health insurance and would like to use it for your private treatment, you’ll need to check whether your policy covers the care you need. When you contact your insurance provider, be sure to have your membership or policy number to hand.

During the call, let your insurer know that you would like your treatment to take place at Practice Plus Group. They will then confirm your policy coverage and identify a recognised consultant who works with Practice Plus Group, ensuring your care is authorised correctly with us.

If your insurer asks for a consultant’s name, simply repeat that you wish to be treated at Practice Plus Group, and they will help direct you to an approved consultant practising here.

3. Pre-authorisation

In some cases, you might need a GP referral. In this instance, your insurer will instruct you to go back to your GP to get one. If you don’t need one, your insurer will give you a pre-authorisation number. Keep this handy; you’ll need it to book an initial consultation with one of our consultant orthopaedic surgeons. You’ll also need to check whether the pre-authorisation includes just the initial consultation, or any diagnostic tests needed (such as blood tests or MRI scans). Please note, some health insurance providers have a specific pathway for musculoskeletal (MSK) patients to follow.

4. Choose a private hospital and consultant

Your insurer will be able to provide you a list of our expert consultants that are registered with them. You’ll need to choose which you’d like to see for your initial consultation.

This is a big decision to make and more information about our consultants, their specialities, and experience is available on our website. You should also take a look at our blog about how to find a knee consultant near you.

5. Initial consultation

Once you’ve chosen which consultant you’d like to carry out your treatment, give us a call on 0330 828 1621 or submit an online enquiry form. One of our team will be in touch within a few days to book you in for an initial consultation at a time that suits you. Your consultation gives you a comprehensive understanding of your condition, and what comes next. If additional tests (like MRI or CT scans) are recommended, your consultant will explain all options in detail, empowering you to make informed decisions.

6. Your surgery

Once your consultant has provided a diagnosis, he or she will devise a treatment plan.

James Wood, Content Specialist