Is Minimally Invasive Spine Surgery Covered By Insurance?

If you suffer from back pain, chances are you want to explore treatment options. Whereas some back pain may be fixed with physical therapy or medication, some issues must be treated surgically. Surgery can be costly, so researching your options will be imperative.  

While traditional surgery may be a viable option for some patients, minimally invasive surgery is also an attractive option. This procedure boasts a faster recovery, less pain, and only a small incision. It may seem like the obvious choice, but only a handful of doctors are skilled enough to practice this form of surgery. Dr. Hanson is the only orthopedic spine surgeon in Minnesota to perform endoscopic hemilaminectomies, foraminotomies, microdiscectomies and nerve transections. 

Minimally invasive spine surgery is performed with many different surgical implements, including lasers, endoscopes, computer-assisted navigation systems, and operating microscopes. This allows the procedure to be performed through a small incision. The decision to use a specific technology is based on the needs of the patient.

Luckily, most insurance plans should cover minimally invasive spine surgery.

Spine surgery is only performed to treat an actual medical condition. Because it is not a cosmetic procedure, insurance companies should cover the cost of spine surgery as long as a doctor determines it is medically necessary and the patient has completed the conservative care requirements set by their specific insurance. 

How Much Does Minimally Invasive Spine Surgery Cost?

The cost of minimally invasive spine surgery can vary depending on the patient’s condition, the length of the procedure, and the surgeon’s fees.  However, it is a much cheaper alternative to traditional surgery. A 2011 study published in SAS Journal showed the cost of a minimally invasive transforaminal lumbar interbody fusion was $14,183.00 on average while the cost of open surgery was $18,633.00. The cheaper costs are due to the fact that a minimally invasive procedure does not have to be performed in a hospital setting. It is an outpatient procedure, so many take place in surgery centers. Patients are able to go home after outpatient procedures, eliminating the cost of a hospital stay.

How much you pay out-of-pocket will depend on your own insurance coverage. You will have to consider your deductibles and copays because they vary across insurance plans. If you have a high deductible and copay, then you may pay a substantial amount out-of-pocket. If you have a high premium, then you may only have to pay a small amount out-of-pocket, or nothing at all.

You will also need to make sure your doctor accepts your insurance plan. Some surgeons may not accept various private insurance plans because some insurers won’t agree to pay the amount the surgeon believes they should be paid for each service. 

Each year, doctors and insurance companies negotiate prices for every service they offer. If the doctor doesn’t believe the insurance company is being fair, then they won’t accept that insurance at their practice.

Does Medicare Cover Spine Surgery? 

Typically, Medicare should cover spine surgery that is determined medically necessary by a doctor as long as the patient has completed the conservative care requirements set by their specific insurance.

However, how much you end up paying out-of-pocket will depend on where you receive the surgery and how you receive your Medicare benefits. 

Medicare may only cover doctor and procedure fees. Therefore, you may have to pay a facility fee. Depending on where the surgery takes place, this cost can vary. Some surgeries may be performed in a hospital, whereas some can be performed at a surgery center. Surgery centers may be physician-owned or specialize in a certain procedure. Dr. Hanson performs minimally-invasive surgeries at both hospitals and surgery centers in the Twin Cities and Duluth.

Original Medicare (Part A and Part B) does not have an annual out-of-pocket limit. However, Medicare Advantage plans (Part C) have an annual out-of-pocket spending limit. This means that if you spend over a certain amount of money out-of-pocket, you may be reimbursed for the cost of covered services that went beyond the out-of-pocket limit.

There are certain portions of a surgery that can and cannot be billed through Medicare. Because of these complexities, we encourage everyone to contact our office to learn about financing options.