Surgery for rotator cuff tears is warranted when a patient has failed conservative measures or has a tear that is so large that it is causing significant dysfunction of the shoulder. Insurance companies typically like to see patients that have gone through a conservative treatment and not gotten better. When I say that, I mean things like trying anti-inflammatory medications, home exercise programs, and even steroid injections such as cortisone in the shoulder should be considered first. Once a patient has had each of these and failed to improve to a lifestyle or a point that they’re satisfied with, a lot of times those need to be undertaken first before surgical intervention is considered. Insurance companies will almost always pay for this kind of surgery once those criteria have been met.