After discussing surgical options, our patients at DISC Sports & Spine Center frequently have a common question: “How much is spine surgery going to cost?” And it is understandable—they want to feel better, but they don’t want to break the bank in the process.
Though DISC is in-network with most major insurance providers, the cost of spine surgery can vary from insurance provider to insurance provider. Here are some things to consider when meeting with a potential surgeon and estimating your costs.
Understand Your Insurance Benefits
Health insurance can be confusing, especially because there is a wide range of plans and coverage. So it is important to spend some time becoming familiar with how your plan’s benefits work. Contact your insurance company directly to understand your particular insurance provider benefits.
The following features of your individual insurance will determine how much you have to pay out of pocket for spine surgery:
- Co-payment, or co-pay: This is a fixed amount you’ll pay for covered medical services. Your co-pay may be higher or lower for different services. For example, you may have a specific co-payment amount for an office visit, admission to the hospital, or a prescription medication.
- Deductible: Many insurance plans have a deductible, which is the amount you have to pay out of pocket during the year before your health insurance coverage will start. Be sure you know your deductible and how close you are to meeting it. Some plans’ deductibles may be $500 or less, while others may be in the thousands. Your deductible or out-of-pocket costs will vary depending on if you are seeing an in-network provider or an out-of-network provider.
- Co-insurance: This refers to the percentage of medical costs you’ll pay versus what your insurance will pay after you’ve met your deductible. For example, if your insurance pays 80 percent, you are still responsible for the other 20 percent of your costs until you hit your out-of-pocket maximum. This price will vary depending on your type of insurance and whether your carrier is in or out of network.
- Out-of-pocket maximum: This refers to the highest amount you can spend on your healthcare for the year before your insurance will start paying 100 percent. Your co-pays, deductible, and co-insurance will all factor into your out-of-pocket maximum.
If you have secondary health insurance or a health savings account (HSA), these can help offset some of your surgery expenses as well.
The Importance of Financial Transparency
Still overwhelmed? At DISC Sports & Spine Center, we can help you take it one step further. We have a financial coordinator who meets with every patient prior to surgery. She will outline exactly what your plan covers and help provide an estimate for what you can expect to pay out of pocket. This can help provide you with a better idea of your financial obligation so you aren’t blindsided after the fact.
Some spine surgeons are also starting to “bundle” the pricing of their services and partner with insurance companies, allowing you to know all of your costs up front by combining them into a single fee. DISC is currently doing this with Blue Shield through Global One and UnitedHealthcare and is hoping to expand to include other insurance networks as well. After patients pay their initial co-pay, they are out of the billing cycle.
DISC understands that having surgery is a big decision, so we want to ensure that all of our patients have the information they need—financial and otherwise. We encourage questions, and we welcome family involvement. You should feel comfortable and confident in the care that we can provide.
If you’d like to learn more about your spine surgery options, schedule an appointment with one of DISC’s expert physicians. You just may find that your ideal treatment fits within your budget, and you’ll have our dedicated support throughout the entire process.
About the author
Grant D. Shifflett, MD Dr. Grant D. Shifflett is a fellowship-trained orthopedic spine surgeon. Handpicked by Dr. Robert S. Bray Jr. to join DISC Sports & Spine Center, Dr. Shifflett specializes in the application of minimally invasive and microsurgical techniques to the entire spectrum of cervical, thoracic and lumbar spinal conditions, from the simple to the most complex. Whether treating a patient with chronic pain or an acute injury, his ultimate goal is to restore function and quality of life with minimal tissue disruption. Read more articles by Grant D. Shifflett, MD.