If you have back pain, it may be necessary to have surgery on your spine to ease your symptoms and improve your spinal health. We’ll look at how insurance covers spine surgery and what tools can be used to manage a patient’s out-of-pocket surgical costs in the sections below.
A spine issue can be treated with a variety of surgeries. Among the possibilities are:
- The doctor opens up the spine to operate on it in traditional spine surgery. This invasive surgery is done in a hospital and takes a long time to recuperate from.
- Spine laser surgery entails utilizing a laser to operate on the spine, allowing the doctor to make only a few small incisions near the spine. This minimally invasive surgery can be done as an outpatient procedure with a quicker recovery period.
- Other minimally invasive spine procedures – Other minimally invasive spine surgeries, in addition to spine laser surgery, may be useful. Nerve stimulation and endoscopic spine surgery are two examples.
Only when a medical ailment affecting the spine necessitates spine surgery. As a result, the cost of spine laser surgery and other types of spine surgery is covered by insurance companies. Simply check to see if your doctor accepts your insurance plan.
What you pay out of pocket depends on the specifics of your insurance plan. Your out-of-pocket payments could be significant if you have a high deductible and copay. However, if your premium is high, you may have modest out-of-pocket payments, or maybe none at all.
Although insurance covers spine laser surgery and other types of spine surgery, patients with a high deductible may not be able to pay their total out-of-pocket expense all at once. If this is the case, patients can use a variety of alternatives to finance their surgery, allowing them to get the therapy they need right away while spreading the cost over a longer period of time.
Many people utilize health-care credit cards, which are specifically meant to be used for medical bills. Others turn to patient financing companies, which specialize in medical procedure funding.
Financing options that aren’t specifically for medical care can also be utilised. Patients using regular credit cards with a high credit limit, for example, may charge the treatment to their card. Another alternative is to take out loans or lines of credit.
Dr. Sukdeb Datta will be delighted to meet with you to discuss whether or not spine laser surgery is appropriate for your condition. Please fill out the form below to book your consultation, or call the Datta Endoscopic Back Surgery and Pain Center at (212) 430-0312.
What is the average cost of 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 procedure 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 major medical problems ranged from about $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 charges for these procedures are roughly twice as high as the average 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 factors that allow these states to deliver care at a lower cost may prove useful in the pursuit of cost optimization and the broader pursuit of value driven healthcare.”
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.
What qualifies for back surgery?
If conservative therapy have failed and your pain is persistent and disabling, back surgery may be a possibility. Back surgery often improves accompanying pain or numbness that travels down one or both arms or legs more consistently. Compressed nerves in the spine are a common cause of these symptoms.
Does insurance cover spinal decompression surgery?
- For patients who do not have health insurance, spinal decompression normally costs $20 to $200 per visit, with 20 to 35 treatments totaling $400 to $5,000. The Kansas City Spine Decompression Center, for example, charges $20 per session for a total of $400; the Mitchell Back and Neck Pain Chiropractic Clinic in Oklahoma charges $65 per session for a total of no more than $1500. A normal treatment at the Kerrville Spine Center in Texas costs around $3,000. The cost is determined by the geographic region and the type of spinal decompression machine utilized at the facility; some machines are significantly more expensive than others, and thus the per-session cost might be significantly greater.
- For patients with insurance, average out-of-pocket fees are a proportion of the overall treatment cost, usually between 10% and 50%, or as much as $2,000.
- Each spinal decompression therapy lasts between 30 and 60 minutes. A pelvic harness is used to stabilize the lumbar spine while the patient is lying on a computer-controlled spinal decompression machine. To alleviate pressure between the discs, the machine makes minor modifications to the back position.
- Before beginning spinal decompression treatment, some chiropractors like to view an MRI of the back. Find out how much an MRI costs.
- Some chiropractors provide discounts or special offers that are only available for a short time. Carney Chiropractic Care in New York, for example, occasionally offers a free spinal decompression trial.
- Spinal decompression is a service provided by several chiropractors. The American Chiropractic Association has a state-by-state chiropractor locator.
- Some patients are not ideal candidates for spinal decompression, such as those who are pregnant, have certain forms of cancer, osteoporosis, or have had lumbar fusion surgery.
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.
- Laminectomy/laminotomy: An opening is made over a nerve or spinal cord to relieve compression of those tissues. The words laminectomy and laminotomy refer to the location and size of the incision in the posterior parts of the spine. This is a type of decompression as well.
- Spinal decompression and fusion: This procedure combines decompression and spine stabilization, and it is used to relieve pressure on “pinched” nerves and/or the spinal cord, as well as to stabilize the spine. During the procedure, pressure is relieved, and the spine is stabilized using hardware that is anchored to bony elements of the spine.
- Anterior cervical discectomy and fusion: In some ways, this is a spinal decompression and fusion procedure, but it is performed from the front of the spine, as opposed to the most common decompression and fusion procedures, which are generally performed from the back. It is also performed on the neck, as indicated by the name. It has earned a separate spot on this list because it is very commonly performed.
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 recovery period experienced by the patient, however, is determined by the extent 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 condition 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.
Can insurance company deny surgery?
Procedures that are more expensive or intrusive than safer, cheaper, or more effective alternatives are denied by insurance carriers. Rather than a bad faith denial, it’s possible that your insurance just isn’t aware of the operation or that another error has occurred.
It’s recommended calling your doctor and your insurance company if your claim has been refused. It’s conceivable that your claim was wrongly coded. The insurer may correct the error if you clarify the condition, the indication, and the therapy. Before approving your claim, the insurance may require some more evidence, which you or your doctor can give. Of course, before you call, double-check that the treatment isn’t expressly prohibited by your insurance coverage (for example, controversial drug treatments). Your insurance rejection lawyer can assist you in determining which operations are covered under your policy.
Is it better to have surgery in the morning or afternoon?
The best time is in the morning. When it comes to surgery scheduling, the time of day you choose can have a significant impact on the result and recovery of your procedure. In a 2006 Duke University study, researchers discovered that procedures scheduled between 3 and 4 p.m. had a greater likelihood of post-operative vomiting, nausea, and pain.
What is considered emergency surgery?
Emergency surgery is aimed to deal with life-threatening issues as rapidly as possible. A patient management team must resuscitate and stabilize the patient, as well as prepare the patient for surgery and perform post-operative and recovery operations.
Diagnostic tests may be ordered after the physical examination is completed and the patient is as stable as feasible. X-rays, CT and MRI scans, EKGs, and lab work are some of the tests that doctors use to figure out what’s wrong and how serious the illness is.
Is back surgery a major surgery?
Myth #1: Spine procedures are all significant operations. Although the spine is a huge section of the body, that does not mean that all spinal surgeries must be major. Several spinal operations are minimally invasive, which means the surgeon only makes a few small incisions rather than a huge one.