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Health Care & Insurance

Who Pays the Bills?

Here's a rundown of what insurers cover.

Health insurers rely on your doctor to decide whether you need surgery, says Mohit Ghose, of America's Health Insurance Plans, a trade group. Most plans cover joint-replacement surgery and the treatments leading up to it. Your doctor may have to go to bat for you to get insurance coverage for some of the newer procedures, such as cell transplantation. No matter what type of surgery you face, make sure that everyone involved in the procedure belongs to your network. "You don't want the anesthesiologist or some other provider to be out of the plan," says Ghose.

On average, joint-replacement surgery costs $22,500 to $29,000 (the average discounted rate paid by Aetna in three urban areas). But your out-of-pocket cost will depend on your plan.

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Physical therapists represent the mainstay of joint conditioning and rehabilitation. Fees vary widely; a ballpark range might be $60 to $75 for every 15 minutes of therapy. Nonetheless, your insurance plan may require a doctor's prescription and limit coverage to, say, 30 sessions a year or to a certain number of days per condition. As of 2006, Medicare caps outpatient physical and speech therapy at a total of $1,740 a year per beneficiary.

Athletic trainers also provide rehab and can design workouts that prevent problems, says Marjorie Albohm, of the National Athletic Trainers' Association. "With the right exercise, you can get in better shape and extend your exercise years." Certified athletic trainers charge $65 to $125 an hour; some insurance plans cover their costs for rehab.