Prospective patients often ask if our procedures are experimental, while past patients express concern that insurance companies attempt to avoid paying for procedures by stating that they are experimental. As such, I thought it would be a good idea to address this question and provide information for persons who are considering any medical procedure.
Approved Innovative & Technologically Advanced Spinal Procedures
FDA Approved Instrumentation – One of the most common misconceptions regarding minimally invasive, laser assisted surgery is that “the procedures are not approved.“ First, I would like to clarify that the FDA approves instruments, not procedures. The Holmium YAG laser, which is utilized during Laser Spine Institute’s procedures, as well as other urologic, orthopedic and gastroenterologic procedures, was approved by the FDA over a decade ago.
AMA Approved CPT Codes – Laser Spine Institute’s physicians utilize Current Procedural Terminology (CPT) codes to bill for their services, which are approved by the American Medical Association. All indemnity insurance companies, as well as Medicare, recognize and use CPT codes to process claims. In addition, we routinely submit medical records to insurance companies for claims processing and reimbursement. Each insurance company processes claims differently, based on the patient’s benefit plan. Your costs may vary depending on:
• Specific plan design
• Actual services you receive
• Cost of services provided
• Area in which you receive services, i.e. location
• Whether your services are provided by in- or out-of-network physicians and facilities
• Changes to Medicare reimbursement methodology (if applicable to your plan)
• Insurance company’s reimbursement and other claim policies.
Minimally invasive spine procedures are beyond the scope of traditional methods. While patients see this method as an advancement with significant advantages, such as shorter recovery time and lower infection rates, some insurance plans did not cover these procedures. Today, virtually all insurance plans cover these procedures and Laser Spine Institute is negotiating with several others that are not yet in contract. In the interim, we have a team of professionally-trained staff who handle the entire process on our patients’ behalf – from pre-certification and authorization through claims processing. This dedicated team is available to answer any questions patients may have or discuss their particular claim with an insurance carrier. Their customer-centric mindset and intensive training accounts for the department’s success in helping our patients to secure payment from insurance companies. To find out if our procedures are covered under your plan, click here or call 1-866-454-2911.