According to Modern Healthcare, a common back surgery can cost upwards of $100,000. If you were to pay it out of pocket, that’s a large sum. Most health insurance coverage, fortunately, cover back surgery when it is medically necessary.
Consider not only the expense of surgery, but also the price of drugs, MRIs, and other testing, as well as rehabilitation and disability. The upfront expenditures are staggering, ranging from $169,000 for a lumbar fusion to $112,000 for a cervical fusion.
Learn how to discuss back surgery and other medically necessary procedures with your health insurance company. When the paperwork is completed correctly, insurance coverage runs more smoothly. The procedure is relatively easy to follow:
- The paperwork is completed and submitted to your carrier by the SSI billing staff.
- The cost is paid by the insurance company, minus any co-pays and deductibles that you are responsible for.
SSI’s professional team will ensure that the documentation necessary by your insurance company are completed correctly. Invest your time and efforts in preparing for your back surgery and subsequent rehabilitation. The SSI team will warn you about any potential problems before your surgery, such as:
Insurance companies have an appeals mechanism that you and your doctor can use if you believe the decision was made incorrectly. In most cases, an appeal will be successful if:
- The insurance company was given inaccurate information, which your doctor has addressed.
- Your doctor offers peer review paperwork regarding the surgery’s appropriateness and effectiveness.
- Your doctor presents further data to support the surgery’s medical necessity.
- Your doctor contacts the insurance company’s medical director to clear up any misunderstandings.
Your SSI team works tirelessly to ensure that you receive the care you require to live a pain-free life. We bring you up to date on your physical and financial progress. Take the steps below to make your insurance coverage work as smoothly as possible. We’ll take care of the rest:
- Make sure your SSI and insurance have your current address and phone number.
- Tell your SSI team about all of your insurance policies, including Medicare, which covers the majority of medically essential surgeries, and any other supplemental insurance plans.
- Notify your doctor’s office if you have any gaps in your premium coverage.
- Request a cost estimate before to surgery so you can budget for any co-payments.
- If your insurance doesn’t cover the necessary back surgery, ask for information about helpful government agencies.
What is the average cost of a back surgery?
The researchers looked at Medicare data from 2012 to see how much an anterior cervical discectomy and fusion (ACDF) and a posterior lumbar fusion cost (PLF). Patients with pain and/or instability in the upper (ACDF) or lower (PLF) spines are commonly treated with these two procedures.
Total knee arthroplasty (TKA), another popular orthopedic operation that does not involve the spine, was also evaluated for comparison. The study focused on direct expenses, which are the amounts paid by Medicare or other payers to health-care providers (such as surgeons or hospitals). The majority of prior cost-benefit assessments of spinal surgery have focused on chargesthe amount that physicians bill payers.
A single-level ACDF operation cost around $14,000 on average in the United States, while a single-level PLF cost around $26,000. (These total costs accounted for both professional and facilities expenses.) The average cost of KA was around $13,000, with TKA costing $22,000 in patients with other significant medical issues.
“The cost of each surgery varied significantly across the country,” write Dr. Spiker and coauthors. ACDF expenditures ranged from $11,000 to $25,000, whereas PLF costs were between $20,000 and $37,000. The cost of TKA for patients without serious medical problems ranged from roughly $11,000 to $19,000.
Except for ACDF, all procedures had considerable regional variations, with the lowest costs in the Midwest and the highest expenses in the Northeast. PLF expenses ranged from $24,000 to $28,000 in the Midwest and the Northeast. Primary TKA cost $12,000 versus $14,000, while TKA with serious medical problems cost $21,000 compared $25,000.
Total expenditures for all four procedures were strongly associated with the state’s cost of living index at the state level, but not with the population of the state.
For Medicare and other payers, spinal fusion operations such as ACDF and PLF are a substantial source of expenses. In the United States, an estimated 3.6 million spinal fusions were performed between 2001 and 2010, costing more than $287 billion.
The new study is one of the first to look at costs rather than charges when it comes to spinal fusion surgery. According to Dr. Spiker and colleagues, the reported total expenditures for these treatments are around twice as high as the typical costs.
The findings reveal that Medicare pays for spinal fusion surgery at a wide range of prices. The TKA cost figures reveal that the differences aren’t just restricted to spinal surgery.
Although the state cost-of-living index is one associated aspect, the study does not show what is underlying the cost discrepancies. According to Dr. Spiker and his coauthors, “Studying the elements that allow these states to deliver care at a lower cost may prove useful in the goal of cost optimization and the larger pursuit of value driven healthcare.”
Is herniated disc surgery covered by insurance?
A laminectomy, which is commonly conducted to cure spinal stenosis, costs $50,000 to $90,000 for people who do not have health insurance. Fortunately, most health insurance policies include back surgery if it is recommended by a doctor. Most insurance plans cover spinal surgery, and Medicare covers back surgery in most cases. If the deductible has been reached, typical out-of-pocket costs for patients insured by insurance would be a co-insurance payment of between 10% and 40% of the procedure, for a total of $200 to $2,000 or more, up to the yearly out-of-pocket maximum.
A herniated disc operation that isn’t covered by insurance can cost anywhere from $20,000 to $50,000, depending on the surgeon, anesthesiologist, and facility fees. A minimally invasive outpatient microdiscectomy is on the low end of the spectrum, while an inpatient open discectomy with a hospital stay is on the high end. If ordered by a doctor, herniated disc surgery is usually covered by health insurance. If the deductible has been reached, typical out-of-pocket costs for patients insured by insurance would be a co-insurance payment of between 10% and 40% of the procedure, for a total of around $2,000, up to the yearly out-of-pocket maximum.
A spinal fusion, which is often done to treat issues such as a slipped vertebrae or other spinal instability, normally costs between $80,000 and $150,000 for those without health insurance, and sometimes even more! A procedure that uses high-end titanium implants instead of a donor’s bone is usually more expensive. Fortunately, the operation would cost around $5,000 depending on your insurance.
How long does it take for insurance to approve back surgery?
Depending on the insurance company, the process of gaining surgery approval can take anywhere from 1 to 30 days. Your account is examined by our billing department once your insurance approval has been received. Before surgery, we request that all outstanding balances be settled in full.
How much does a lumbar laminectomy cost?
In a hospital outpatient department, the typical cost of a laminectomy (partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine) is $5,699, with Medicare paying $4,559 and the patient paying $1,139.
Spinal Decompression costs vary depending on the severity of the condition and the area being treated. Most patients will see results after 20 treatment sessions spread out over a six-week period, costing between $1500.00 and $2000.00. Depending on the specific policy, insurance may cover a percentage of these costs. Difficult situations can be more expensive since they demand more office visits. It’s worth noting that the overall out-of-pocket expenditures of spinal decompression are typically much lower than the deductibles and co-insurance payments connected with surgery. Our staff will be pleased to discuss payment options with you, including savings for pre-paid treatment sessions.
Our clients frequently inquire about the cost of spinal decompression and whether it is appropriate for their circumstances. Dr. Sands is ready to perform an assessment and determine the cost of spinal decompression for you, as well as devise a strategy that is tailored to your specific needs and insurance coverage. Our objective at Sands Chiropractic in Pompano Beach, Florida, is to provide you with accurate information so that you can consider your spinal surgery alternatives.
What is L5 S1 surgery?
A spinal fusion is a surgical procedure in which one or more vertebrae (bones in the spine) are fused together by screws, bolts, and/or plates. The hardware can be attached to the spine from the front (anterior) or the back (posterior). Often, the disc between the vertebrae is removed and replaced with bone or a spacer. The L5 S1 Fusion refers to the surgical level.
What is the most common spine surgery?
Spine surgery can be a wonderful alternative for many individuals who are enduring pain or discomfort as a result of a spinal disease, allowing them to return to their daily activities.
Patients must be thoroughly qualified by an experienced orthopedic spine surgeon and completely informed of their treatment options before undergoing surgery. Any operation can be frightening, and knowing the facts is a crucial step toward recovery.
Decompressing the neurological structures and stabilizing the spine are the two most common spine procedures.
During spinal surgeries, the categories are frequently combined. More specifically, there are four main procedures that account for almost 90% of all spine surgeries:
- Discectomy: A discectomy involves removing herniated disc material that is pressing on the nerves or spinal cord. Discectomy is a sort of decompressive surgery.
- A laminectomy or laminotomy is a procedure that involves making an aperture over a nerve or spinal cord to relieve compression.
- The words laminectomy and laminotomy refer to the size and location of the opening in the spine’s posterior components. This is a type of decompression as well.
- Decompression and fusion of the spine is the most common spine surgery in the United States, and it is used to relieve pressure on “pinched” nerves and/or the spinal cord, as well as to stabilize the spine. Pressure is eased during the treatment, and the spine is stabilized with hardware anchored to bony parts of the spine. Decompression and spine stabilization are combined in this treatment.
- Anterior cervical discectomy and fusion: This treatment is similar to a spinal decompression and fusion. The difference is that it is conducted from the front of the spine, as opposed to the back, as is the case with most decompression and fusion surgeries. It is also performed on the neck, as the name suggests. Because it is so widely performed, it has earned its own spot on this list. Nerves or the spinal cord can be pinched in the cervical spine, which is an indication. Because the neurological structures in this portion of the spine are vulnerable to disc compression, we remove the disc, restore disc space by placing a spacer between the vertebrae, and utilize instrumentation to speed the mending of the vertebrae with each other, a process known as fusion. Another treatment that incorporates decompression and spine stabilization is this one.
Because each surgical technique affects the body in different ways, recovery after the four main forms of back surgery laminectomy, discectomy, spinal fusion, and artificial disc replacement may vary. The level of damage caused by spinal problems such as degenerative disc disease, spinal stenosis, spondylolisthesis, and other disorders of the spine has a substantial impact on recovery following these surgical operations.
Post-Operative Recovery from Back Surgery
The length of time a patient spends recovering after surgery is often determined by his or her age and physical condition. The procedure used will also have an impact on your experience.
Except for the time it takes to recuperate following back surgery, which can range from 3-4 weeks to a year, most patients leave home with less discomfort in their lower back or neck than they did before the surgery. Spinal fusion has the longest post-operative recovery time, ranging from eight months to a year. And that’s before the patient can return to their regular routine.
Total disc replacement (artificial disc surgery), which has largely replaced spinal fusion as the treatment of choice for the majority of common spinal diseases, may only take 3 weeks to 3 months to recover from, despite the fact that it is significant surgery. The actual recuperation duration experienced by the patient, however, is determined by the degree of the operation and the patient’s physical condition.
Laminectomies (which often include foraminotomy) and discectomies are now comparatively short outpatient procedures because to advances in medical technology. Post-operative recovery from these operations may need 1-2 weeks of light activity, depending on the breadth of the surgery and the patient’s condition.
Patients should follow their doctor’s instructions exactly as they would for any other back surgery. They should also keep in mind that the patient’s full recovery is dependant on his or her continued compliance with postoperative therapy (e.g., physical therapy, fitness, nutrition, medication). Patients must also keep all follow-up appointments and notify their doctors if their health changes or if the pain or numbness returns.
Recovery from Laminectomy, Foraminotomy Surgeries
Patients with spinal stenosis experience progressive discomfort that is concentrated at or near the spine, as well as numbness in the arms, hands, or legs and feet. The nerve channels (also known as the “foramen”) gradually narrow as “spinal stenosis” develops. Laminectomies/foraminotomies are used to treat spinal stenosis in any part of the spine (cervical, thoracic, or lumbar). Microendoscopy, a medical technological innovation, allows many surgeons to do this treatment as an outpatient procedure. It is possible that the treatment will take 1-2 hours to finish. This reduces the predicted recuperation time to a week or so of rest at home. 1-2 months of restrictions against hard lifting, bending, stooping, and specified sports activities may also be recommended by your doctor.
Recovery from Discectomy Surgery
Damage to a spinal disc or degeneration are the most common causes of back and neck discomfort (herniated disc, degenerative disc disease). Localized pain and prolonged numbness (tingling) in the extremities are possible side effects (arms, fingers, legs, toes). To relieve nerve compression that is causing the discomfort and numbness, a surgeon will prescribe a discectomy, which involves removing a part of the bulging spinal disc. The good news is that discectomies are virtually often performed as an outpatient operation lasting 1 to 2 hours, thanks to medical innovations like microendoscopy. As a result, the patient is discharged home right away and may require up to one week of home recuperation before resuming to most of their physical activities. Depending on the degree of the treatment and the patient’s medical and physical condition, the surgeon will undoubtedly prescribe easing back into heavy lifting and particular athletic activity for 1 to 2 months.
Recovery from Spinal Fusion Surgery
Fewer and fewer doctors are suggesting spinal fusion as a surgical treatment for degenerative disc disease and other spinal problems that have failed to respond to non-surgical treatments. Spinal fusion, like any major operation, necessitates meticulous attention and planning on the part of the patient. Spinal fusion was invented around the start of the twentieth century and has recently been surpassed by artificial disc replacement surgery as one of the oldest medical treatments still in use today. The rationale is simple: fusion aims to keep the area of the spine that causes pain and suffering from moving. This necessitates the use of titanium screws, rods, plates, and other implants “Two or more spinal segments are “stabilized.” Following that, the surgeon will “graft” the parts together to form a single solid bone structure. Even with the most current medical equipment, spinal fusion can take up to 8 hours to accomplish and can take anywhere from 6 to 12 months to recover from.
Recovery from Artificial Disc Replacement Surgery
When one or more spinal discs have been severely damaged or failed, a surgeon may prescribe extensive surgery. Artificial disc replacement surgery (or total disc replacement) is increasingly being recommended by surgeons as the best option for most patients. The idea is to replace worn-out spinal discs with artificial discs consisting of metal and a semi-flexible biopolymer that mimics the pliability of a real disc. Artificial disc replacement surgery is a relatively recent operation that was first offered in the United States in 2000 and has subsequently been approved by the FDA following multiple positive clinical trials. The main difference is that patients report complete range of motion and flexibility following surgery. Furthermore, while artificial disc replacement surgery can take up to 2 hours, many people recover completely in 6 weeks, depending on the scope of the surgery and the patient’s physical condition prior to surgery.