Laser Spine Institute physicians are in contract with Medicare for the professional services that they provide at Laser Spine Surgery Center (LSSC), which is an ambulatory surgery center that is not part of a licensed hospital.
Why is Laser Spine Institute Facility not covered by Medicare?
Laser Spine Institute facility itself is not in contract with Medicare so a facility fee is incurred by the Medicare patient as an upfront out of pocket cost. Laser Spine Institute has the strongest desire to provide every patient with not only the most professional and qualified service from its surgeons and staff, but with the most state-of-the-art amenities and equipment from its cutting edge facilities. Over 40% of the total patient population who has surgery with Laser Spine Institute is a Medicare patient, and many have the majority of everything covered through secondary insurance.
Will Medicare ever consider adding Laser Spine Institute procedures to the Ambulatory Surgical Center (ASC) List?
Over the past few years, as Laser Spine Institute’s high outcomes continue to gain recognition, Medicare’s medical advisors have considered adding the procedures on the Ambulatory Surgical Center (ASC) list. We anticipate that Medicare will at some point in the future reimburse these procedures in an ASC. A chief objective is to educate Medicare and other managed care payors, even in an agreement to reimburse costs cannot be achieved in the short-term.
Laser Spine Institute’s incredible outcomes have and continue to generate interest from payors and managed care companies desiring mutually favorable partnerships. To summarize, Medicare currently does not recognize our surgical procedure on the ASC list of covered surgical procedures. More about this topic can be found on the Medicare Federal Register/Vol. 74,No. 223/Friday, November 20, 2009/Rules and Regulations #60603.
Why does Laser Spine Institute not include other major insurers?
Laser Spine Institute is in contract with United Healthcare and its affiliates. We are pleased with that agreement and we are constantly working to include other major insurers. When we enter into a contract with an insurer, it is imperative that our cost is covered. If we are not properly reimbursed for our costs, then that will compromise the quality of care that we can provide to our patients. We are not willing to make even the smallest concession in our patient experience as we are committed to delivering maximum results to every person we treat.
We take great pride that we can deliver the quality of care to help people find freedom from pain. We have worked hard to find three partners to help prospective patients finance their surgery: Care Credit, Chase, and Fifth Third Bank. These institutions are able to help many people.
Why Some Doctors Don’t Accept Medicare or Insurance?
While this is not Laser Spine Institute’s direction, there is a trend of some practices away from Medicare and insurance. Below is a link to offer that perspective as well. Again, Laser Spine Institute makes every effort to educate the insurance companies about our procedures and we accept most insurance.
April 24, 2010 Article: “Why are more doctors opting out of Medicare and insurance programs?”
In the above-referenced article, you will find that there are a number of reasons why some doctors don’t accept Medicare.
- Medicare regularly cuts the rates of reimbursement, which means doctors earn less for office visits and various procedures.
- There is a longer delay than ever before for doctors to get reimbursements from Medicare.
- Medicare has a very convoluted, bureaucratic process that allows some tests and treatments, refuses to pay for others, and limits how a doctor can practice medicine.
- Private insurers set low reimbursement rates for various services and treatments, rates that may not even cover a doctor’s overhead.
- Insurers often systematically make reimbursement deliberately difficult, complicated and time-consuming.
- When reimbursement is approved, payments from insurers can be extremely slow to reach the physician.
- Doctors may need additional staff to handle the extra paperwork, phone calls, resubmissions, and negotiation with insurance companies.
If you have not spoken with us within the last 12 months, please call 1-866-LSI-DOCS (362-7574) to speak with a patient coordinator about your individual plan so you can make the best decision for you.