There are times when a herniated spinal disc, also commonly known as a "slipped disc" or “ruptured disc,” may require treatment with a traditional surgical procedure such as an open discectomy. In comparison to a microdiscectomy, a minimally invasive procedure in which a fragment of a spinal disc is removed, an open discectomy requires a larger incision and typically a longer healing and recovery time, which could add to the total costs involved. For this reason, many patients may have concerns about what insurance typically covers. This article will discuss issues related to insurance coverage as it applies to an open discectomy.
Insurance Typically Covers an Open Discectomy Ordered by a Doctor
If your doctor makes a formal recommendation for an open discectomy because of the nature of your symptoms and any other factors unique to your particular situation, the procedure is likely to be covered by insurance, at least to some extent. A doctor or spine care specialist may recommend this type of herniated disc surgery if the following circumstances apply:
• Your herniated disc isn’t responding to conservative treatment
• Your symptoms are severe and debilitating
• The resulting discomfort is severely impacting your quality of life
Each Particular Policy Determines What the Patient Will Pay Out of Pocket
Whether or not you'll have out-of-pocket expenses with an open discectomy depends on the details of your particular insurance policy. For instance, if you have a higher deductible and copay, you may have more out-of-pocket costs. Conversely, if you have a plan with a higher premium, you may have minimal out-of-pocket expenses or even none at all.
Medicare Insurance Coverage
If Medicare is your primary health insurance provider, your open discectomy will likely be covered. As is the case with private or marketplace insurance, a doctor must order the open discectomy and deem it medically necessary for your situation.
Coverage for the Hospital Stay
With an open discectomy, you'll likely need to stay in the hospital or surgery center for a short time before being discharged. As with the discectomy procedure itself, insurance coverage for the extent of your hospital stay will depend on what's included in your policy. Some health insurance policies only cover a portion of costs that aren’t specifically involving the surgery itself. Medicare Part A covers inpatient care, and Part B covers your hospital stay.
Note: If you have Medicare supplemental insurance for prescriptions, any post-surgery medications may be covered. Review your individual policy for details.
Insurance Coverage for Physical Therapy
Recovery after most spine surgeries involves physical therapy. This is more likely to be the case with an open discectomy due to the added stress on surrounding tissues and the need to strengthen spine-supporting muscles. If your doctor recommends physical therapy as a necessary part of your open discectomy recovery, it is likely to be covered by insurance. Again, the extent of this coverage depends on your policy. With physical therapy, coverage may include:
• Physical therapy itself but not any related equipment (e.g., back braces, spinal support belts, etc.)
• The cost of physical therapy, but only for a therapist approved by your insurance provider
• Physical therapy–related expenses up to a certain limit or percentage of costs
Discectomy costs are different for each individual and depend on factors such as disc height and the size of the hole left in the outer ring of the disc after surgery. If the hole in the disc is larger than a standard pencil eraser, the patient has a significant risk of experiencing a reherniation. Patients with a large hole in the outer ring of the disc are more than twice as likely to reherniate after surgery. These reherniations often require additional surgery or even a larger spinal fusion operation. Barricaid is a bone-anchored device shown to reduce reherniations by closing the hole in the disc after a discectomy, and 95 percent of Barricaid patients didn’t undergo a reoperation due to reherniation in a 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and doesn’t require any additional incisions or time in the hospital.
If you have any questions about the Barricaid treatment or how to get access to Barricaid, you may ask your doctor or contact us at 844-288-7474.
For full benefit/risk information, please visit: https://www.barricaid.com/instructions.
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