Health Insurers Spend Billions on Unnecessary Joint Surgery

Imagine being an osteoarthritis patient and being told by your insurance company that they will not cover stem cell or PRP therapy. You are told that neither is covered because the insurance company deems them experimental. So what does your doctor recommend? Joint replacement surgery.

As astounding as it seems, insurance companies are spending billions of dollars every year on unnecessary joint replacement surgeries. What’s worse is that they don’t think anything of it. Your average insurance company will sign off on joint replacement surgery just as easily as a well child visit with the pediatrician. Yet they won’t approve a stem cell or PRP therapy that could completely eliminate the need for surgery.

A Serious and Costly Problem

A lot of what goes on in the healthcare arena doesn’t make sense. For example, shop around for an MRI and you’ll find quite a range of prices. A hospital might charge $3500 for a patient with health insurance but only $2,000 for self-pay. An independent clinic might beat them both at just $1,000.

There seems to be no rhyme or reason explaining the disparity in costs or what insurance companies will and will not cover. Getting back to joint replacement surgeries, a 2018 study from the UCLA Center for Health Advancement demonstrated that as many as 33% of all knee and hip replacement surgeries in the U.S. are unnecessary. Those procedures cost insurance companies an estimated $8.3 billion a year.

The most important word here is ‘unnecessary’. What makes them unnecessary? A range of factors. For example, there may be other treatments that would work just as effectively. Then there is age. Knee and hip replacements for 30-year-old patients are just not reasonable. There are other treatments that work better for younger patients.

Regenerative Medicine Treatments

A great option for many patients is regenerative medicine, explains Apex Biologix in Salt Lake City. Apex says that there is plenty of clinical evidence demonstrating the efficacy of PRP therapy for early- and mid-stage osteoarthritis. Meanwhile, evidence in support of stem cell therapy as an osteoarthritis treatment is growing as well.

It would seem that insurance companies would be willing to give serious consideration to regenerative medicine in light of the cost of joint replacement surgery. But to date, they are not. They simply refuse to cover regenerative medicine procedures based on the false assumption that regenerative medicine is experimental.

Meanwhile, the same insurance companies will spend billions on unnecessary surgeries. Moreover, doctors will continue recommending surgery knowing full well that they shouldn’t be. Why the medical community is not as upset over this practice as they are over so-called ‘unregulated stem cell clinics’ is anyone’s guess.

A Different Way of Thinking

The fact that doctors are recommending and performing unnecessary surgical procedures is a strong indication that Western medicine needs a different way of thinking. There is something terribly wrong with a system that condones unnecessary surgeries even while being supposedly committed to doing no harm.

To be clear, joint replacement surgery is not a minor procedure. It is considered major surgery and one with plenty of risks and complications. To boot, joint replacement surgeries are not guaranteed to work. Many patients go through the entire process of surgery and rehab only to find they are no better off.

Regenerative medicine is the new way of thinking we need. It seeks to find ways to encourage the body to heal itself rather than replacing parts or writing prescriptions. It seems like insurance companies have a built-in reason to pursue regenerative medicine. Why they do not is a mystery.