Arthroscopic surgery for shoulder labrum tear?
Hello, Doctor.
I have been experiencing recurrent shoulder dislocations, which have caused significant disruption in my daily life.
After undergoing an MRI at the hospital, it was found that I have a tear in my shoulder labrum, and I need to undergo arthroscopic surgery for repair.
The doctor mentioned that my surgery will require three suture anchors, but he said that health insurance only covers two, and I would need to pay out-of-pocket for the third one (approximately 6,000 TWD).
Additionally, the arthroscopic surgery itself requires a co-payment of over 20,000 TWD.
I would like to ask if these costs are normal.
Why does health insurance only cover two anchors while the third one must be paid out-of-pocket? Also, is the cost of the surgery reasonable? Do you have any other suggestions? I have recently become unemployed and my financial situation is not good, which is why I am raising these questions.
Thank you for taking the time to respond; I greatly appreciate it.
Mr. Gao, 50~59 year old female. Ask Date: 2021/11/11
Dr. Zhan Xian reply Orthopedics
Hello Mr.
Gao, due to various medical conditions, some health insurance reimbursements have limits.
If the surgery requires materials that exceed the insurance coverage, the physician will explain the out-of-pocket costs, and it will be used only after the patient’s consent.
Additionally, the price of screws may vary due to differences in material design, so please discuss this with your attending physician.
Reply Date: 2021/11/11
More Info
Shoulder labrum repair surgery, particularly when performed arthroscopically, is a common procedure for addressing issues such as recurrent shoulder dislocations and labral tears. The costs associated with this surgery can vary significantly based on several factors, including the specific hospital, the complexity of the procedure, and the materials used during the surgery.
In your case, it appears that your insurance coverage (健保) is only providing reimbursement for two of the three anchors required for your surgery. This situation is not uncommon, as insurance policies often have specific guidelines regarding the number of devices or materials they will cover for certain procedures. The decision to cover only two anchors may be based on the insurance provider's assessment of what is considered medically necessary for the average case of labral repair. However, if your surgeon believes that a third anchor is essential for the success of your surgery, it is worth discussing this further with them. They may be able to provide documentation or a letter of medical necessity to your insurance company, which could potentially lead to additional coverage.
Regarding the out-of-pocket costs you mentioned—approximately 6,000 NTD for the third anchor and over 20,000 NTD for the arthroscopic procedure—these figures can be considered within the normal range for such surgeries in Taiwan. However, costs can vary widely depending on the facility and the surgeon's expertise. It is advisable to obtain a detailed breakdown of the costs from your hospital, including any additional fees that may arise during the procedure or post-operative care.
If you are facing financial difficulties due to unemployment, you might want to explore options for financial assistance through the hospital. Many healthcare facilities have programs to help patients who are struggling to afford necessary medical care. Additionally, you could inquire about payment plans that allow you to spread the costs over time, making it more manageable.
In terms of your overall situation, it is crucial to prioritize your health and ensure that you receive the necessary treatment for your shoulder condition. Delaying surgery could lead to further complications or chronic pain, which may ultimately result in higher costs and a longer recovery period. Therefore, while it is essential to consider the financial implications, it is equally important to weigh the potential long-term benefits of undergoing the surgery as recommended by your healthcare provider.
Lastly, if you have any further questions or concerns about the procedure, costs, or insurance coverage, do not hesitate to reach out to your healthcare team. They can provide you with the most accurate information tailored to your specific situation and help you navigate the complexities of your healthcare needs.
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