Can health insurance or ayushman cover revision surgery after a failed bone fracture operation?

Hello,

Yes, if the plate, rod, screw, or other implant used during a previous fracture surgery fails, breaks, becomes loose, or causes complications, another surgery (revision fracture surgery) may be required. In many cases, both Ayushman Bharat (PM-JAY) and private health insurance can cover the cost of the revision surgery, provided the treatment is medically necessary and is covered under your policy or scheme.

When is a Second Surgery Required?

A revision fracture surgery be recommended if

• The implant (plate, rod, or screw) breaks or becomes loose.

• The fracture does not heal properly (non-union or delayed union).

• The bone heals in the wrong position (malunion).

• There is an infection around the implant.

• Severe pain, swelling, or difficulty in walking or using the affected limb continues after surgery.

• The implant causes irritation or mechanical failure.

Common Symptoms of Implant Failure

Patients experience

• Persistent or increasing pain at the fracture site.

• Swelling, redness, or warmth around the operated area.

• Difficulty walking or bearing weight.

• Reduced movement of the affected limb.

• Deformity or abnormal movement of the bone.

• Fever or discharge from the surgical wound (if infection is present).

Treatment Options

The treatment depends on the reason for implant failure and include

• Medicines for pain relief and infection (when appropriate).

• X-rays, CT scans, or MRI to assess the implant and bone healing.

• Physiotherapy for selected cases.

• Revision fracture surgery if the implant has failed or the fracture has not healed properly.

Revision Fracture Surgery

During revision surgery, the orthopedic surgeon :

• Remove the damaged or loose implant.

• Fix the fracture again using a new plate, rod, or screws.

• Perform bone grafting if there is bone loss or delayed healing.

• Clean infected tissue if an infection is present.

• Stabilize the bone to promote proper healing.

Recovery depends on the patient's age, bone quality, overall health, and the severity of the condition. Regular follow-up and physiotherapy are important for a successful recovery.

Is Ayushman Bharat (PM-JAY) Applicable?

Yes, if you are an eligible PM-JAY beneficiary and the revision fracture surgery is medically required, treatment is available cashlessly at PM-JAY empanelled hospitals under the applicable orthopedic package. Coverage depends on medical evaluation, package guidelines, and hospital approval.

How to Check Whether the Hospital Accepts Ayushman Bharat (PM-JAY)?

• Visit the official PM-JAY Hospital Finder.

• Select your State and District.

• Search by Hospital Name or Orthopedics specialty.

• Confirm that the hospital is PM-JAY empanelled.

• Contact the hospital's Ayushman Help Desk to verify whether revision fracture surgery is covered before admission.

Is Private Health Insurance Applicable?

Yes, most health insurance policies cover revision fracture surgery when it is medically necessary. Coverage depends on your policy terms, sum insured, waiting periods (if applicable), network hospital availability, and approval from the insurer.

Before admission, you should

• Inform your insurance company.

• Obtain pre-authorisation for cashless treatment if using a network hospital.

• Submit the required medical reports and previous surgery records.

How HexaHealth Can Assist You

If you are planning revision fracture surgery, we can help you

• Connect with experienced orthopedic surgeons.

• Find nearby partner hospitals offering fracture revision surgery.

• Check whether your Ayushman Bharat or health insurance can be used.

• Assist with appointments, hospital admission, insurance documentation, and cashless treatment support.

Please share your city/state and let us know whether you have an Ayushman Card, ECHS, CGHS, or private health insurance. We will help you find the most suitable hospital and guide you through the next steps.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth