How Much Does Artificial Disc Replacement Surgery Cost?
It’s not uncommon for many health insurance carriers to deny a doctor’s recommendation for lumbar artificial disc replacement surgery. In many cases, patients exhaust all of their internal and external appeals and are left with two choices: to endure their chronic back pain or pay out-of-pocket for back surgery.
If you’re considering the latter, you should fully understand what a disc replacement surgery costs out of pocket and what other expenses you’ll need to consider before giving your surgeon the go ahead. Keep in mind that final costs may vary, in some instances by geography. The goal of this article is to give you a general idea what you can expect to pay so you—along with your health care team—can make informed and educated long-term health and financial decisions that are free of hidden costs and surprises.
Bundled Costs for Artificial Disc Replacement
Some hospital systems have begun offering artificial disc replacement surgery in what is known as bundled medical payments. This payment option is a flat fee that accounts for the cost of your implant, the complete surgical team—your surgeon, assisting surgeon, general surgeon/access surgeon, anesthesiologist, hospitalist—and associated services provided by the hospital—intraoperative neuromonitoring, recovery room, etc. This helps hospitals and doctors keep costs down. Bundled payments are paid up front to the hospital system by the patient, or in dividend payments designed to make reimbursement manageable.
However, some health insurance providers and even self-insured employers offer bundled payments, as well. Check with your employer or your insurance provider to find out if you can benefit from this program. This way, you can confidently enter surgery knowing what you will pay out of pocket, and what your health insurance may or may not contribute.
Services that may not be provided within the bundle include: X-rays, MRIs and other imaging, EKG tests, lab work and blood tests, physical therapy and any other related specialists, and medical equipment (i.e., back brace). Each bundled payment plan is different, in other words, so it helps to be informed of that prior to surgery. If you want an example of what these fee structures look like, Texas Back Institute Center for Disc Replacement and Prairie Surgicare list theirs online.
NOTE: If you are a service provider and woulld like to share your fee structure in this article OR if you are a patient and know of a service provider that has their pricing online, please contact us so we can update article.
One of the most important things you can request from your surgeon and/or the hospital about the bundled fees is to make them detail everything that is covered and not so you are fully prepared financially. For any services or items that are not covered, have them provide you with the fees for each or the best contact to have that discussion.
While the cost of surgery is the bulk of your medical expenses, you’ll want to also consider external variables leading up to and after your procedure. Budgeting for these will help you paint a more complete financial picture. For instance, if you are having surgery in another city, state or region of the country, estimate the cost of travel, lodging, meals, and accommodations (if they are not included in a payment bundle).
You will most likely need to arrive a day or two before surgery to have pre-op consultations and require an additional 1-3 days afterward for follow up and rest before leaving. Some people extend their post-op stay to allow more rest to ensure they’re fully prepared to travel home as comfortably as possible.
Other Financial Considerations
You’ll also want to look ahead to recovery. During the recovery phase, you’ll incur expenses such as co-pays for follow-up care, prescriptions, medical equipment and/or personal assistant devices (i.e., elevated toilet seat, shower bars) and physical therapy. You’ll be out of work for a period of time (how long depends on the extent of your surgery, for example). Be sure to consider the economic impact and make the necessary adjustments to your home budget.
Tips for Handling Post-Op Bills
Once you’ve returned home and have started your recovery, you may receive bills for various services. When reviewing the contents, be sure to:
- Review each document in detail and check for any additional billing you did not expect.
- Contact the hospital (or biller) to verify what it is for and why it wasn’t included in the bundle.
- If not part of the bundle, make sure to ask if it was run through insurance. If not, file it with your health insurance carrier to avoid additional out-of-pocket expenses just in case it can be covered.
Hopefully you learned what you should expect when it comes to paying for your artificial disc replacement surgery. If you want ideas on how to finance your upcoming back surgery, read “How to Finance Your Back and Spine Surgery.”