Orthopedic Care — It’s Covered

In this “It’s Covered” series, we’re delving into the many healthcare services that Comfort™ covers that most traditional plans do not.

As the pandemic hit, orthopedic clinics started shutting down and elective surgeries like knee and hip replacements were delayed. This, coupled with new work-from-home strains like not wearing shoes and less ergonomic workspaces, has created quite a groundswell of need for orthopedic care in 2022.

The road to fixing an orthopedic issue can feel daunting at first, but with Comfort, we’ve demystified that journey. What’s more, we’ve worked to drive down the out-of-pocket costs for members — every step of the way.

Seeing a Specialist

Far too often, traditional health plans present barriers like referral requirements and out-of-pocket costs for members who need to see specialists like orthopedic doctors. But not with Gravie.

We took a hard look at the hoops individuals typically have to jump through to get care, and then we worked hard to streamline the process as much as possible. While those on traditional plans usually need to have to get a referral from their primary care physician to see a specialist, Comfort removes that referral requirement and empowers members to go directly to an orthopedic doctor first.

What’s more, while many traditional plans charge members a copay or coinsurance for a specialist office visit, Comfort members have specialist visits fully covered at no cost (on top of no-cost primary care visits).

Receiving a Diagnosis

When it comes to orthopedic issues, there’s almost always imaging involved. For many people on private health plans, when they hear “imaging” they think “expensive.” And with most plans, that is completely accurate — too many individuals have had an x-ray and then felt the sting of receiving a large bill for it a few weeks later.

For Comfort members, imaging associated with an office or clinic visit is always fully covered. If you have an orthopedic issue and your doctor needs labs or imaging to better understand the problem, don’t hesitate! We want you to get the information needed to fix the problem as quickly and painlessly as possible. 

Surgery

If surgery is where your orthopedic journey leads, then you can be confident that Gravie has you covered every step of the way. With Comfort’s expansive network, it’s likely that coverage for your preferred provider and surgery center would be in-network. And for any additional expenses that may be incurred, Comfort offers the protection of clear out-of-pocket maximums that help keep you in control of your costs.

Additionally, any generic medications prescribed to patients post-procedure are always covered under Gravie Comfort. For anything else, we’ve taken the guesswork out of what you’ll pay at the pharmacy counter. Non-preferred brand drugs are a $100 co-pay and specialty drugs are a $125 co-pay, all without needing to meet out-of-pocket maximums.

Follow-Up Care

As you settle into life post-diagnosis, and potentially post-procedure, you can have the confidence of knowing your in-network primary care and specialist visits will always be covered with Comfort.

Those in need of physical therapy will also be relieved to find that Gravie covers those in-network visits as well, without requiring a copay. Since physical therapy plans could require many months of visits or more depending on the injury, this benefit lifts a heavy financial burden off members, and frees them up to focus on what matters — rehabilitating as quickly as possible. 

At the outset, orthopedic issues can appear complex and costly. But with Comfort, members can have peace of mind knowing we’re working to make the process as seamless and straightforward as possible. Here’s what one member had to say after her recent ACL replacement:

“Having been through multiple knee injuries and surgeries, the most daunting thing about orthopedic issues is how long the road to recovery is from the surgery itself, to seemingly endless physical therapy after. It gets discouraging quick. Knowing Gravie is in my corner, removing so many of the costs associated with orthopedic care is a huge financial and emotional barrier lifted.”

To learn more about how Gravie is making it easier to access orthopedic care with Comfort, contact us.