Is Spine Surgery Covered By My Insurance?

Category: Spine Surgery | Author: Stefano Sinicropi

Spinal x-ray

If you are injured or develop a spinal condition that isn’t responding to conservative care, you may be told that a corrective surgical procedure is in your future. Odds are one of your first thoughts will be to how this procedure may affect you financially. Will insurance pick up the bill for your spine surgery, or are you going to need to have to pick up a significant portion of the cost by yourself? Below, we explain whether or not back surgery is typically covered by insurance.

Does Insurance Pay For Back Surgery?

Every insurance plan is different, so we can’t sit here and say that back surgery is always covered by insurance or it is always ineligible. With that said, spine surgery is covered by health insurance the majority of the time. The key here is that in order for the procedure to be covered, it needs to be deemed medically necessary.

This means that you’re going to need to undergo an evaluation by a medical professional. During this examination, they’ll assess your injuries and provide a diagnosis and some treatment options. Even though surgery may be one of the options they discuss, it doesn’t mean that the procedure will be covered by insurance. In many instances, your doctor will recommend conservative treatment options first. Since surgery is a major undertaking and is more expensive, doctors will oftentimes pursue less invasive and less expensive treatment options first. After your first appointment, they may suggest rest, lifestyle changes, physical therapy or similar techniques. At this juncture, an operation would not be covered because the jury is still out on whether or not it is medically necessary.

However, if these conservative options fail to provide relief, or if your condition was so severe that it was unlikely to respond to conservative care, making surgery the first recommendation, then your provider may decide that surgery is medically necessary. At this point, your procedure will be covered by your insurance.

It’s also important to note that the specific type of spine surgery or how it is performed doesn’t matter. Whether it is a traditional open procedure, minimally invasive surgery, laser surgery or robotic-assisted surgery, it should be covered by health insurance so long as your doctor agrees that it is medically necessary.

Again, it’s important to remember that your individual insurance plan is unique and will likely come with its own deductible. Depending on the plan you chose, you may still have significant out-of-pocket expenses in order to meet your deductible. The procedure may also only be covered up to a certain percentage, meaning your health insurance provider may cover 80 percent of the cost after you meet your deductible, so there may be additional expenses to account for. It pays to take a closer look at your insurance coverage and do what you can to start managing your finances to help prepare for any upcoming medical costs.

One last thing that we want to note is if the injury that leads to spine surgery occurs while you are working. If you are injured during the course of your employment, your medical expenses may be covered by workers’ compensation. If you file a successful workers’ compensation claim, any medical expenses that you pay will be reimbursed to you through your injury claim. The expenses will ultimately be paid by your employer’s workers’ compensation provider, not your health insurance provider.

We are happy to answer any questions you have about insurance coverage or the cost of a specific spine surgery, and we can also help you get in contact with your health insurance provider if they are better equipped to answer certain questions. We don’t want spine surgery to be a major financial burden on you or your family, so we’re here to help in any way we can.

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