Meniscus is a C-shaped structure that is present in the knee joint comprising of two parts, one being lateral and the other being medial. It acts as a cushion between the thigh bone and shin bone.

Meniscal tears or ruptures are common injuries that people may face and can happen due to various activities like sports, accidents, etc. A meniscal tear can limit movement and cause pain and discomfort to an individual. The treatment for such injuries can be expensive, and in some cases, the insurance company may refuse to pay for it.

Therefore, it’s essential to understand meniscus rupture and insurance claims.

Types of Meniscus Ruptures

The outer third part of the meniscus receives blood supply, and damage in this area has a high chance of healing.

On the other hand, the inner two thirds of the meniscus do not receive blood supply, and if a tear occurs in this area, the chances of healing are minimal. There are three types of meniscus tears based on their location:.

1. Vertical Tear

A vertical tear in the meniscus can occur due to knee degeneration or might be a sign of aging. It happens when a part of the meniscus separates from the shank and forms a flap. It can cause discomfort and limit mobility in the knee.

2. Radial Tear

Radial tears are perpendicular to the meniscus’s edge and extend inwards. These types of tears typically occur in the meniscus’ outer third region and can heal without surgery.

However, if it occurs in the inner two-thirds, it can require surgery to heal.

3. Horizontal Tear

Horizontal tears are parallel to the meniscus’ edge and can happen due to degeneration or aging. The healing process for horizontal tears in the knee is slow, and they can cause pain and discomfort.

Treatment for Meniscus Rupture

Before we discuss the insurance part, it’s important to understand how the meniscus rupture is treated.

For a minor meniscus tear, the recommended treatment is RICE (rest, ice, compression, and elevation) along with medication to reduce inflammation and pain. For a severe tear, the doctor may recommend surgery, which can cost several thousand dollars.

Insurance Coverage for Meniscus Rupture

Meniscus rupture is a common injury, and it’s essential to understand if insurance policies cover the cost of treatment. Generally, most insurance policies cover the cost of treatment, whether it’s surgery or non-surgical.

However, some insurance providers have specific clauses where they may not cover the cost of treatment if the injury is due to a pre-existing condition or a non-sports injury. You must read the insurance policy and check if it covers the treatment of a meniscus tear.

Filing an Insurance Claim for Meniscus Rupture

If you suffer from meniscus rupture, you must file an insurance claim as soon as possible. Here are the steps to file an insurance claim:.

: 1. Contact your insurance provider

Call or visit the insurance provider’s office and inform them of the injury. They will guide you through the process and help you with the paperwork.

You might need to provide the doctor’s report and other necessary documents to support your claim.

: 2. Keep all bills and receipts

You must keep all the bills, receipts, and medical reports carefully. Keep a record of all the medical treatments, medications, and surgeries.

This information will help you support your claim and ensure the insurance provider reimburses you for all the expenses.

: 3. Follow the procedure

The insurance provider will give you a set of procedures to follow to process the claims. Make sure you adhere to all the requirements and submit all the necessary documents in time. Failure to do so can result in a denial of the claim.

Conclusion

Meniscus rupture can occur due to various reasons, and it’s essential to understand how insurance policies cover it or not.

Generally, most insurance providers cover the cost of treatment, but it’s crucial to read and understand the insurance policy’s clauses. If you suffer from a meniscus tear, follow the insurance provider’s procedures to ensure a smooth and hassle-free claim process.